P1507Experience in chronical lead extraction with ablation catheter and snare via femoral route

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Uslu ◽  
A Kup ◽  
S Demir ◽  
I Balaban ◽  
K Gulsen ◽  
...  
Keyword(s):  
The Body ◽  
Snare Complex ◽  
Lead Extraction ◽  
Time Interval ◽  
Ablation Catheter ◽  
Femoral Approach ◽  
Icd Leads ◽  
Locking Stylet ◽  
Gooseneck Snare ◽  
Manual Traction

Abstract Background   Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads. Methods We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations.  Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical)  or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead. Results A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection  in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37  (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in  93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed  the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p < 0.001). Conclusion Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.

P1179Transvenous extraction of partially controlled leads

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Benak ◽  
G Bencsik ◽  
A Makai ◽  
R Pap ◽  
G Klausz ◽  
...  
Keyword(s):  
Success Rate ◽  
Essential Role ◽  
Independent Predictor ◽  
Lead Extraction ◽  
Limited Data ◽  
Partial Control ◽  
Femoral Approach ◽  
Lower Success Rate ◽  
The Mean ◽  
Locking Stylet

Abstract Background Lead control has an essential role in successful transvenous lead extraction (TLE), however, there is limited data about leads without adequate control Objective The aim of the study was to assess the success rate, complexity, and safety of partially controlled lead extraction. Methods A single-center retrospective analysis of consecutive patients underwent TLE procedures was performed. Results From May 2012 to Aug 2019, 137 consecutive patients (76% male, mean age: 65 ± 15 years) underwent TLE procedures (273 leads, 93% infective indication, 37% with high voltage leads). Locking stylet was used in 83% (n = 224) of the leads. Advancement of the locking stylet all the way to the tip was not possible in 30.4% (n = 68) of the leads, resulting in partial control (LC- group). The mean age of the lead was significantly higher (11.06 +/- vs 7.76 +/- 6.3, p = 0.001) and the success rate was lower (76.1 % vs 93.2%, p = 0.001) in LC-. The need for femoral approach was more frequently in LC- leads (36.9% vs 16.2%, P= 0.001). Inadequate lead control was an independent predictor of lead extraction failure (OR: 5.27, 95% CI: 1.71-5.27, p= 0.004) and femoral approach (OR: 2.1, 95% CI: 1.054-4.08, p= 0.035). Three out of five major complications occurred in LC- group. Conclusions Partial lead control results in lower success rate and more complex TLE procedures.

scholarly journals Comparison of efficacy of different endovascular lead extraction techniques

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Bracke ◽  
N Verberkmoes ◽  
N Rademakers ◽  
M Van 't Veer ◽  
B.M Van Gelder
Keyword(s):  
Clinical Success ◽  
Lead Extraction ◽  
Extraction Techniques ◽  
Single Centre ◽  
Left Behind ◽  
Femoral Approach ◽  
Alternative Approach ◽  
Icd Leads ◽  
Procedural Success ◽  
Single Technique

Abstract Background Reports on lead extraction often concern a single technique, rendering direct comparison between techniques difficult. Purpose We compared efficacy and complications of consecutively used endovascular extraction techniques in a single centre. Methods Single centre observational study of consecutive lead extractions from 1997 to 2019. The preferential technique used over time was at first a laser sheath (LS), subsequently a femoral approach (FA) if feasible, and finally rotational mechanical sheaths (RMT). The FA remained the preferential initial technique for atrial and coronary sinus leads during the latter period. Extraction results are reported per lead for the initial technique before any alternative approach was initiated. Results A total of 1725 leads (including 222 ICD) leads were extracted in 775 patients. Primary endovascular extraction was attempted in 1703 leads (median implant time 6.0 yrs. [IQR 2.7–10.2]) with the remainder being surgically removed. Traction sufficed to remove 588 leads (median implant time 2.4 yrs. [IQR 1.2 - 4.7]). The table shows the radiological and procedural success of the initially used technique per lead. Including use as backup technique there were 7.4%, 0.5% and 1.2% major complications with respectively LS, FA, and RMT. Including backup approaches, clinical success (lead completely removed or only lead fragment <4cm left behind without mayor complication) for endovascular extraction of the 1703 leads was 94.8%. Conclusion The laser sheath has an inferior procedural outcome compared to rotational mechanical sheaths or a femoral approach which is largely the results of a higher complication rate. The femoral approach and mechanical rotational sheaths are seemingly equally effective, but the femoral approach is not suitable for many ICD leads and technically more demanding for ventricular leads. In current practice, the combination of a femoral approach and rotational mechanical sheaths yields optimal results. Funding Acknowledgement Type of funding source: None

scholarly journals Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

2019 ◽  
Vol 7 (15) ◽  
pp. 2447-2451
Author(s):  
Ibrahim El-Zoghby ◽  
Amr Nawar ◽  
Mohamed Soliman ◽  
Mahmoud Kenawy ◽  
Khaled Hussien ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Lead Extraction ◽  
Extraction Techniques ◽  
Factors Associated ◽  
Cardiac Implantable Electronic Devices ◽  
Cardiovascular Implantable Electronic Devices ◽  
Permanent Pace ◽  
Pace Maker ◽  
Locking Stylet ◽  
Manual Traction

BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed.

scholarly journals Efficacy and safety of transvenous lead extraction using a liberal combined superior and femoral approach

2020 ◽  
Author(s):  
Sing-Chien Yap ◽  
Rohit E. Bhagwandien ◽  
Dominic A. M. J. Theuns ◽  
Yunus Emre Yasar ◽  
John de Heide ◽  
...  
Keyword(s):  
Removal Rate ◽  
Systemic Infection ◽  
Complete Removal ◽  
Lead Extraction ◽  
Lead Removal ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Related Complication ◽  
Femoral Approach ◽  
Locking Stylet

Abstract Purpose During transvenous lead extraction (TLE), the femoral snare has mainly been used as a bail-out procedure. The purpose of the present study is to evaluate the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach. Methods This is a single-center observational study including all TLE procedures between 2012 till 2019. Results A total of 264 procedures (median age 63 (51–71) years, 67.0% male) were performed in the study period. The main indications for TLE were lead malfunction (67.0%), isolated pocket infection (17.0%) and systemic infection (11.7%). The median dwelling time of the oldest targeted lead was 6.8 (4.0–9.7) years. The techniques used to perform the procedure were the use of a femoral snare only (30%), combined rotational powered sheath and femoral snare (25%), manual traction only (20%), rotational powered sheath only (17%) and locking stylet only (8%). The complete and clinical procedural success rate was 90.2% and 97.7%, respectively, and complete lead removal rate was 94.1% of all targeted leads. The major and minor procedure-related complication rates were 1.1% and 10.2%, respectively. There was one case (0.4%) of emergent sternotomy for management of cardiac avulsion. Furthermore, there were 5 in-hospital non-procedure-related deaths (1.9%), of whom 4 were related to septic shock due to a Staphylococcus aureus endocarditis after an uncomplicated TLE with complete removal of all leads. Conclusion An effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach.

scholarly journals Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction

2016 ◽  
Vol 46 (2) ◽  
pp. 186 ◽  
Author(s):  
Uk Jo ◽  
Jun Kim ◽  
You-Mi Hwang ◽  
Ji-Hyun Lee ◽  
Min-Su Kim ◽  
...  
Keyword(s):  
Lead Extraction ◽  
Gooseneck Snare ◽  
Manual Traction

Preparation and In Vitro Evaluation of Resealed Erythrocytes as A New Trend in Treatment of Asthma

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Mohammed Ibrahim ◽  
Alaa Zaky ◽  
Mohsen Afouna ◽  
Ahmed Samy
Keyword(s):  
In Vitro Release ◽  
Human Erythrocytes ◽  
The Body ◽  
Blood Levels ◽  
Time Interval ◽  
Burst Release ◽  
Prolonged Release ◽  
Nocturnal Asthma ◽  
Carrier Erythrocytes

Carrier erythrocytes are emerging as one of the most promising biological drug delivery systems investigated in recent decades. Beside its biocompatibility, biodegradability and ability to circulate throughout the body, it has the ability to perform extended release system of the drug for a long period. The ultimate goal of this study is to introduce a new carrier system for Salbutamol, maintaining suitable blood levels for a long time, as atrial to resolve the problems of nocturnal asthma medication Therefore in this work we study the effect of time, temperature as well as concentration on the loading of salbutamol in human erythrocytes to be used as systemic sustained release delivery system for this drug. After the loading process is performed the carrier erythrocytes were physically and cellulary characterized. Also, the in vitro release of salbutamol from carrier erythrocytes was studied over time interval. From the results it was found that, human erythrocytes have been successfully loaded with salbutamol using endocytosis method either at 25 Co or at 37 Co . The highest loaded amount was 3.5 mg/ml and 6.5 mg/ml respectively. Moreover, the percent of cells recovery is 90.7± 1.64%. Hematological parameters and osmotic fragility behavior of salbutamol loaded erythrocytes were similar that of native erythrocytes. Scanning electron microscopy demonstrated that the salbutamol loaded cells has moderate change in the morphology. Salbutamol releasing from carrier cell was 43% after 36 hours in phosphate buffer saline. The releasing pattern of the drug from loaded erythrocytes showed initial burst release in the first hour followed by a very slow release, obeying zero order kinetics. It concluded that salbutamol is successfully entrapped into erythrocytes with acceptable loading parameters and moderate morphological changes, this suggesting that erythrocytes can be used as prolonged release carrier for salbutamol.

The role of cardiac surgery in transvenous lead extraction (TLE) – experience from high volume center and 3207 procedures

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Tulecki ◽  
M Czajkowski ◽  
S Targonska ◽  
K Tomkow ◽  
D Nowosielecka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tricuspid Valve ◽  
Surgical Intervention ◽  
Clinical Success ◽  
Left Ventricular ◽  
Lead Extraction ◽  
Icd Leads ◽  
Ventricular Lead ◽  
Cardiac Surgeon

Abstract Background The guidelines suggest close co-operation between TLE operating team and cardiac surgery and its key role in the management of life-threatening complications remains unquestionable. But the role of cardiac surgeon seems to be much more extended. Purpose We have analysed the role of cardiac surgery in treatment of patients undergoing TLE procedures. Methods Using standard non-powered mechanical systems we have extracted ingrown PM/ICD leads from 3207 pts (38,7% female, average age 65,7-y) during the last 14 years. Non-infectious TLE indications were in 66,4% of patients. 46% had PM DDD system, 19% PM SSI, 22% ICD, 9% CRT, 4% other systems. In 12% of patients abandoned leads were found. 8% of patients had one lead, 54% - two, 15% - three and 4% - 4–6 leads in the heart. An average dwell time of all leads was 91,5 mth. The lead entry side was left in 96% of patients, right in 3% and both – 4%. Results Procedural success 96,1%, clinical success - 97,8%, procedure-related death 0,2%. Major complications appeared in 1,9% (cardiac tamponade 1,2%, haemothorax 0,2%, tricuspid valve damage 0,3%, stroke, pulmonary embolism <1%). Conclusions Rescue cardiac surgery (for severe haemorrhagic complications) is still the most frequent reason of surgical intervention (1,1%). The second area of co-operation includes supplementary cardiac surgery after (incomplete) TLE (0,8%). The third one is connected with reconstruction or replacement of tricuspid valve, which can be affected by ingrown lead or damaged during TLE procedure (0,5%). Implantation of the complete epicardial system during any surgical intervention (rescue or delayed) should be considered as a supplementation of the operation (0,65%). Some of patients after TLE need implantation of epicardial leads for permanent epicardial pacing (0,6%) and some only left ventricular lead to rebuild permanent cardiac resynchronisation (0,5%). The single experience of large TLE centre indicates the necessity of close co-operation with cardiac surgeon, whose role seems to be more comprehensive than a surgical stand-by itself. Table 1 Funding Acknowledgement Type of funding source: None

scholarly journals Excimer laser lead extraction by femoral approach

EP Europace ◽  
2010 ◽  
Vol 13 (5) ◽  
pp. 757-759 ◽  
Author(s):  
I. Diemberger ◽  
M. Biffi ◽  
C. Martignani ◽  
G. Boriani
Keyword(s):  
Excimer Laser ◽  
Lead Extraction ◽  
Femoral Approach ◽  
Laser Lead Extraction

scholarly journals Analytical and Experimental Analysis of a Free Link in Contact with a Granular Medium

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Dan B. Marghitu ◽  
Seung Lee
Keyword(s):  
Granular Medium ◽  
Stopping Time ◽  
The Body ◽  
Resistance Force ◽  
Time Interval ◽  
The Moment ◽  
Static Resistance ◽  
The Impact ◽  
Resistance Forces ◽  
Empirical Approaches

In this study, the experimental and the simulation results for a planar free link impacting a granular medium are analyzed. The resistance force of the granular medium on the body from the moment of the impact until the body stops is very important. Horizontal and vertical static resistance forces developed by theoretical and empirical approaches are considered. The penetrating depth of the impacting end of the free link increases with the increase of the initial impacting velocity. We define the stopping time as the time interval from the moment of impact until the vertical velocity of the link end is zero. The stopping time of the end decreases as the initial velocity increases. The faster the end of the link impacts the surface of the granular medium, the sooner it will come to a stop. This phenomenon involves how rapidly a free link strikes the granular medium and how it slows down upon contact.

Abstract 11945: Indications and Outcomes Following Transvenous Extraction of ICD versus Pacemaker Leads

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eric W Black-Maier ◽  
Sean D Pokorney ◽  
Robert K Lewis ◽  
Alexander Christian ◽  
Ruth A Greenfield ◽  
...  
Keyword(s):  
Adverse Events ◽  
Dwell Time ◽  
Clinical Success ◽  
Lead Extraction ◽  
Index Hospitalization ◽  
Lead Failure ◽  
Icd Leads ◽  
Pacemaker Leads ◽  
Pacing Lead ◽  
Major Adverse Events

Introduction: Percutaneous transvenous lead extraction of cardiovascular implantable electronic devices (CIEDs) is increasingly common. Although ICD leads are widely considered to be more difficult to extract than pacemaker leads, there are few direct comparisons. Methods/Results: Using a cohort of 368 consecutive patients undergoing lead extraction (dwell time >1 year) between 2005-2012, we compared baseline characteristics/outcomes in extractions involving pacing versus ICD leads. We defined major adverse events (MAE) as any events/complications that required procedural intervention, transfusion, or that resulted in death or serious harm during index hospitalization. Median age was 60.6 yrs and 29.6% were women. There were 136 (37%) pacing lead extractions and 232 (63%) ICD lead extractions. Pacing leads had a longer dwell time (6.14 yrs [IQR 1.2-10.9 ] versus 4.4 yrs [IQR 1.1-6.4], p<0.001) and higher median LVEF (55% [IQR 35-55] vs. 30% [IQR 20-40], p<0.001) compared with ICD lead patients. Indications for pacing and ICD lead extractions included sepsis/endocarditis (21.3% vs. 24.6%, p=0.48), pocket infection (40.4% vs. 34.9%, p=0.29), and lead failure (15.4% vs. 38.8%, p<0.001). There were no significant differences between pacing and ICD lead extractions in median fluoroscopy time (5.5 vs. 8.5 minutes, p=0.86) or femoral bailout rate (4.4% vs. 5.2%, p=0.73). There were similar rates of all-cause MAE during index hospitalization (5.1% vs. 5.6%), death (2.2% vs 3.2%) and clinical success (97.0% vs. 97.0%, p=0.55) in pacemaker and ICD extractions, respectively. Conclusions: ICD leads are more commonly extracted relative to pacemaker leads, and this difference is driven by larger numbers of lead failure within ICD leads. Despite much longer dwell times, major adverse events were similar in pacing lead cases compared with ICD extractions.

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