Lead Management and Lead Extraction

2018 ◽  
Vol 10 (1) ◽  
pp. 127-136 ◽  
Author(s):  
Charles J. Love
Keyword(s):  
Lead Extraction ◽  
Lead Management

scholarly journals Transvenous lead extraction procedures in women based on ESC-EHRA EORP European Lead Extraction ConTRolled ELECTRa registry: is female sex a predictor of complications?

EP Europace ◽  
2019 ◽  
Author(s):  
Anna Polewczyk ◽  
Christopher A Rinaldi ◽  
Manav Sohal ◽  
Pier-Giorgio Golzio ◽  
Simon Claridge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Success ◽  
Signs And Symptoms ◽  
Venous Occlusion ◽  
Lead Extraction ◽  
Blood Cell Count ◽  
Female Sex ◽  
Major Complications ◽  
Lead Management ◽  
Post Hoc

Abstract Aims Female sex is considered an independent risk factor of transvenous leads extraction (TLE) procedure. The aim of the study was to evaluate the effectiveness of TLE in women compared with men. Methods and results A post hoc analysis of risk factors and effectiveness of TLE in women and men included in the ESC-EHRA EORP ELECTRa registry was conducted. The rate of major complications was 1.96% in women vs. 0.71% in men; P = 0.0025. The number of leads was higher in men (mean 1.89 vs. 1.71; P < 0.0001) with higher number of abandoned leads in women (46.04% vs. 34.82%; P < 0.0001). Risk factors of TLE differed between the sexes, of which the major were: signs and symptoms of venous occlusion [odds ratio (OR) 3.730, confidence interval (CI) 1.401–9.934; P = 0.0084], cumulative leads dwell time (OR 1.044, CI 1.024–1.065; P < 0.001), number of generator replacements (OR 1.029, CI 1.005–1.054; P = 0.0184) in females and the number of leads (OR 6.053, CI 2.422–15.129; P = 0.0001), use of powered sheaths (OR 2.742, CI 1.404–5.355; P = 0.0031), and white blood cell count (OR 1.138, CI 1.069–1.212; P < 0.001) in males. Individual radiological and clinical success of TLE was 96.29% and 98.14% in women compared with 98.03% and 99.21% in men (P = 0.0046 and 0.0098). Conclusion The efficacy of TLE was lower in females than males, with a higher rate of periprocedural major complications. The reasons for this difference are probably related to disparities in risk factors in women, including more pronounced leads adherence to the walls of the veins and myocardium. Lead management may be key to the effectiveness of TLE in females.

scholarly journals Numerical Modeling of Vascular Stresses During Lead Extraction: Subclavian vs. Femoral

2020 ◽  
Author(s):  
Mostafa Toloui ◽  
Mark Marshall ◽  
Pierce Vatterott ◽  
Peter Zhang ◽  
Ryan Lahm ◽  
...  
Keyword(s):  
Femoral Vein ◽  
High Stress ◽  
Wall Stress ◽  
Extraction Methods ◽  
Lead Extraction ◽  
Vein Wall ◽  
Femoral Approach ◽  
Stress Levels ◽  
Lead Management ◽  
The Individual

Abstract Transvenous lead extraction is a critical and growing technique used to treat patients with chronically implanted pacemakers and defibrillators. This procedure is commonly executed via the subclavian vein or the femoral vein. Some physicians’ experiences indicate that the femoral approach results in fewer vascular tears. This study is aimed to present a physics-based comparative assessment of intravenous mechanical stresses for chronic lead management between the two approaches. Finite Element (FE) modeling is employed to quantify the vascular stress distributions. A full 3-D model including veins, heart, fibrotic scar regions and the lead was created to simulate the different lead extraction methods. Results: (1) highest stresses are generally in the vicinity of SVC lead attachments; (2) femoral approach results in a ∼uniform distribution of stress over the scar while the subclavian approach leads to patches of concentrated high stress; (3) 2–3 times higher maximum vascular stress during subclavian; (4) insignificant maximum stress at the apex for both; (5) inverse variation of stress levels with: (i) branch-to-scar distance for SVC method; and (ii)vein wall thickness in both methods. (6) lower stress levels for scars with longer attachment lengths. The importance and effectiveness of mechanical stress analysis in risk analysis for chronic lead management is illustrated. Overall, the localized intravascular wall stress is meaningfully higher for subclavian vs. femoral extraction with same SVC shear force. This may help explain the higher rate of SVC tears when extracting from the left subclavian approach. The individual anatomy (e.g. vascular angles) is a key factor in the resulting stress and this understanding may be critical when choosing an extraction approach and future lead design.

Lead management

ESC CardioMed ◽  
2018 ◽  
pp. 2002-2005
Author(s):  
Jean Claude Deharo
Keyword(s):  
Present Status ◽  
Medical Management ◽  
Lead Extraction ◽  
Huge Number ◽  
Implantation Techniques ◽  
Lead Management ◽  
Lead Technology

With the huge number of pacemaker and defibrillator leads implanted worldwide, the term ‘lead management’ has been launched to cover the proper knowledge of lead technology and implantation techniques related to lead integrity and potential extraction, as well as the implementation of lead extraction strategies and methods. The interest of the cardiological community for these topics has probably been reinforced by recent well-publicized lead performance concerns, but also by the general perception that, in our patients, lead-related problems, including infections, lead redundancy, and venous issues, are a major matter of concern. This chapter discusses the technological aspects related to lead performance, the medical management of lead-related issues, and the present status of lead extraction.

Contemporary pacemaker and ICD lead management: techniques for lead extraction

2012 ◽  
Vol 10 (7) ◽  
pp. 875-887 ◽  
Author(s):  
Malini Madhavan ◽  
Matthew J Swale ◽  
Joseph J Gard ◽  
David L Hayes ◽  
Samuel J Asirvatham
Keyword(s):  
Lead Extraction ◽  
Management Techniques ◽  
Lead Management

From lead management to implanted patient management: systematic review and meta-analysis of the last 15 years of experience in lead extraction

2013 ◽  
Vol 10 (4) ◽  
pp. 551-573 ◽  
Author(s):  
Igor Diemberger ◽  
Andrea Mazzotti ◽  
Mauro Biffi ◽  
Giulia Massaro ◽  
Cristian Martignani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Management ◽  
Meta Analysis ◽  
Lead Extraction ◽  
Years Of Experience ◽  
Lead Management

Transvenous Lead Extraction for Cardiac Implantable Electronic Devices

2015 ◽  
Vol 26 (4) ◽  
pp. 320-328
Author(s):  
Julie B. Shea
Keyword(s):  
Patient Outcomes ◽  
Electronic Devices ◽  
Management Strategies ◽  
Lead Extraction ◽  
Comprehensive Understanding ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Cardiac Implantable Electronic Devices ◽  
Individualized Care ◽  
Lead Management

This article illustrates the important role that lead extraction plays in the management of patients with cardiac implantable electronic devices. Individualized care of the patient is paramount when considering lead management strategies. The critical care nurse must have a comprehensive understanding of the indications, procedural considerations, and preprocedural and postprocedural care for patients undergoing lead extraction procedures, thereby improving patient safety and maximizing patient outcomes.

scholarly journals Repeated lead extraction – the new challenge. Experience from 3207 TLE procedures

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kutarski ◽  
L Tulecki ◽  
M Czajkowski ◽  
K Tomkow ◽  
D Nowosielecka ◽  
...  
Keyword(s):  
Management Strategy ◽  
High Volume ◽  
Term Effect ◽  
Lead Extraction ◽  
Funding Source ◽  
First Line ◽  
Long Term Effect ◽  
Lead Management ◽  
Frequent Reason

Abstract Background Transvenous lead extraction (TLE) is optimal option of management of lead-related problems. Usually the procedure has favourable long-term effect. Most of patients get the new or restored pacing system and risk of following lead-related problems may occur again. The knowledge about re-extraction procedures is limited. Methods In high volume centre during the last 15 years 3207 TLE procedures were performed and 1–6 leads (aver 1,65, with mean oldest implant duration 96,6 mth) were extracted using as first line non-powered mechanical tools. Other tools were used if necessary. We analysed data of first TLE procedures and repeated extractions. Results Are presented in the table. Re-extractions include 4,3% of all TLE procedures. Re-infection is less frequent reason for re-extraction (26,8%). Most re-extractions were performed because of dysfunction or damage of lead, which was newly implanted (56) or preserved during previous TLE (20). The last one indicates, that during TLE procedure it should be considered to replace all existing leads, not only these damaged or dysfunctional. Conclusion Re-extractions are safe procedures with very good results. Previously performed extraction is not a risk factor for another TLE procedure. Re-extraction should not be avoided in lead management strategy. Table 1 Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document