Pediatric and Adult Congenital Endocardial Lead Extraction or Abandonment Decision (PACELEAD) Survey of Lead Management

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.

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Endocardial Lead Extraction in the Polish Registry – clinical practice versus current Heart Rhythm Society consensus

Archives of Medical Science ◽

10.5114/aoms.2013.33434 ◽

2014 ◽

Vol 2 ◽

pp. 258-265 ◽

Cited By ~ 6

Author(s):

Michał Chudzik ◽

Andrzej Kutarski ◽

Przemysław Mitkowski ◽

Andrzej Przybylski ◽

Joanna Lewek ◽

...

Keyword(s):

Clinical Practice ◽

Heart Rhythm ◽

Lead Extraction ◽

Endocardial Lead

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Endocardial Lead Extraction

Cardiac Pacing for the Clinician ◽

10.1007/978-0-387-72763-9_6 ◽

2008 ◽

pp. 265-316

Author(s):

Peter H. Belott

Keyword(s):

Lead Extraction ◽

Endocardial Lead

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Surgical Implantation of Endocardial Lead for Adult Congenital Atrioventricular Block Combined with Obstructed Bilateral Subclavian Vein

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.46.114 ◽

2017 ◽

Vol 46 (3) ◽

pp. 114-118

Author(s):

Eisaku Nakamura ◽

Kouichiro Ochiai ◽

Yukie Shirasaki ◽

Hirohito Ishi ◽

Koji Furukawa ◽

...

Keyword(s):

Atrioventricular Block ◽

Subclavian Vein ◽

Congenital Atrioventricular Block ◽

Adult Congenital ◽

Surgical Implantation ◽

Endocardial Lead

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Endocardial lead extraction with transoesophageal echocardiography guidance for cardiovascular implantable electronic device (CIED) related infections: four cases report

10.21203/rs.3.rs-230838/v1 ◽

2021 ◽

Author(s):

Qiaoyu Han ◽

Yi Feng ◽

Hui Ju ◽

Yan Jiang ◽

Feng Ze ◽

...

Keyword(s):

Electronic Device ◽

Complete Removal ◽

Transoesophageal Echocardiography ◽

Pericardial Tamponade ◽

Lead Extraction ◽

Monitoring Methods ◽

Recommended Treatment ◽

Routine Monitoring ◽

Endocardial Lead ◽

Older Populations

Abstract Background With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. The recommended treatment of which involves the complete removal of all hardware, followed by antibiotic therapy and re-implant. Application of transoesophageal echocardiography (TEE) helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Case presentation : We report four cases of CIED infections from single-centre, who were extracted endocardial leads with intra-op TEE monitoring and guidance. Three of them had three fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op TTE, which avoided intra-op embolism. Conclusions Continuously intra-op TEE should be one of the routine monitoring methods in these high-risk endocardial leads extraction procedures.

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

2020 Design of Medical Devices Conference ◽

10.1115/dmd2020-9003 ◽

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.

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Lead management

ESC CardioMed ◽

10.1093/med/9780198784906.003.0465 ◽

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.

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