Music Therapy as an Adjunct in CIED Lead Extraction Procedures

Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.

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Improving Safety of Lead Extraction Procedures by Traction Force Sensing

Case Medical Research ◽

10.31525/ct1-nct03842124 ◽

2000 ◽

Author(s):

Keyword(s):

Traction Force ◽

Lead Extraction ◽

Force Sensing ◽

Extraction Procedures

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Abstract 2141: Lead Extraction in Pediatric and Congenital Heart Disease Patients

Circulation ◽

10.1161/circ.118.suppl_18.s_674-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Joseph Atallah ◽

Charles I Berul ◽

Mark E Alexander ◽

John K Triedman ◽

Edward P Walsh ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Young Adult ◽

Congenital Heart ◽

Extraction Procedure ◽

Right Atrial ◽

Lead Extraction ◽

Extraction Procedures ◽

Simple Extraction ◽

Complex Extraction

Background: Transvenous pacemaker and defibrillator device implant is a rapidly growing practice in pediatric and young adult congenital heart disease. The need for lead extraction is an associated eventuality in certain patients. Although several techniques have emerged in the past few years, the safety and efficacy of lead extraction in the pediatric population remains unknown. We report our experience with lead extraction using simple traction or complex extraction methods. Methods: Retrospective cohort study of all patients having undergone a lead extraction at Children’s Hospital Boston from 2002 to 2008. Lead extraction was defined as simple if only traction was required and complex if it required the use of an interlocking stylet. Results: A total of 114 patients underwent 124 lead extraction procedures with a total of 172 extraction attempts. The average age was 17.1 (2.47– 48.23) years at lead implant and 23.0 (6 –52.7) years at lead extraction. Congenital heart disease was present in 57.3% (71/124) of patients. Extraction by simple traction was achieved for 51 leads (mean lead age=3.1 years), while the remaining 121 leads required complex extraction (mean lead age=7.5 years), of which 32 were abandoned. Of the remaining leads 83/89 (93%) were extracted successfully. Only 2/55 (4%) leads >7.5 years of age could be extracted with simple traction. However, 63/99 (64%) leads >1 and <7.5 years of age were a complex extraction. Multivariable logistic regression analysis showed that a younger lead age (OR=0.7, 95% CI 0.6 – 0.9, P<0.01), silicone-type of lead insulation (OR=7.6, 95% CI 1.6 –36.7, P=0.01) and a lead in the atrial position (OR=3.0, 95% CI 1.1– 8.7, P=0.05) were independent predictors of a simple extraction. There was only one major complication consisting of right atrial perforation and tamponade that was controlled with surgical exploration. There was no mortality related to lead extraction procedures. Conclusion: The majority of leads implanted in pediatric and young adult patients with congenital heart disease can be extracted successfully. Though certain lead characteristics correlated with a simple extraction procedure, the majority of leads >1 year of age will require a complex extraction technique.

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