Late pacemaker lead extraction made simple: no need for dedicated extraction devices?!

Introduction: Late withdrawal of cardiac leads placed in the right atrium, respectively right ventricle, represents a challenging method with multiple risks due to inflammation, clots, and dense fibrotic attachments between leads and vascular or cardiac tissue, which in-creases with the progression of time. A range of devices dedicated to providing a more efficient and less risky extraction procedures have been developed over time. Objective: To assess the procedural risk in the absence of a surgical background in the same hospital, but still located in the same city and using non-dedicated ex-traction devices.
Methods: In the last 3 years, 9 patients underwent pa-cemaker lead extraction located in the right ventricle, respectively right atrium. Long angioplasty sheaths (9 F, 23 cm) were used, after removal of the haemostatic sheath, the angioplasty sheaths being advanced „over the wire” on the lead. As back-up support firm stylets were used. In active fixation leads the extraction was preceded by helix retraction. In all cases the pull-back/ pull-down, push/forth maneuvers were executed after stylet removal.
Results: From the 9 patients, 2 patients had bicameral pacemakers and 7 patients had unicameral pacemakers. The atrium leads were in both patients active fixation leads and from a total of 9 ventricular leads, 5 were active and 4 were passive. The time since implan-tation varied between 8 months and 11 years for the ventricular leads (the 8 months and the 11 years having passive fixation) and between 1.5 years and 10 years for the atrial leads (both active fixation leads, but for the one implanted 10 years ago, the behavior was as for a passive fixation lead, because the lead connector was not functional anymore). There were no major peripro-cedural complications, the only event being the tearing of the intern coil in one atrial lead (which was favored by the previous destruction of the lead-connector), but without negative consequences and with the entirely extraction of the lead. In general the leads were clean, with blood inside the helix cavity when it was about the active fixation leads. An exception was the RV lead ex-tracted after 11 years, which was covered with a fibrous sleeve. Back up support with the angioplasty sheath (9F, 23 cm modified) was necessary in just 4 cases (for the atrial leads and for 3 ventricular leads, which had leads in place for more than 5 years).
Conclusions: Performed with the utmost attention and repeated soft maneuvers of pull up/pull-down, push/ forth, late extraction of the pacemaker leads is not as risky as it might seem, and can be done with standard equipment and without sophisticated and expensive specially created tools. There were no significant differences concerning the maneuvers and the complicati-ons of extraction between passive and active fixation leads.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)