Lead extractions: dissecting adhesions up to the lead‐tip of the right ventricle: safety and success‐rates

Aims Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV‐lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective,...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 2022-01, Vol.45 (1), p.132-140
Main Authors: Witte, Olivier A., Delnoy, Peter Paul HM, Ghani, Abdul, Smit, Jaap Jan J., Ramdat Misier, Anand R., Elvan, Arif, Adiyaman, Ahmet
Format: Article
Language:English
Subjects:
Aged
apex of right ventricle
complications
Defibrillators, Implantable
Device Removal - methods
Equipment Design
Evolution
Feasibility Studies
Female
Heart
Humans
ICD
lead extraction
Male
Myocardium
Netherlands
pacemaker
Pacemaker, Artificial
Prosthesis Failure
Registries
Safety
Statistical analysis
Success
Ventricle
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Summary:Aims Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV‐lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV‐lead extraction requiring dissection up to the myocardium. Methods and results From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand‐powered mechanical Evolution system to extract RV‐leads (n = 185) were examined from a prospective registry. We assessed 4 groups: TLE with the first generation Evolution (n = 43) with (A1,n = 18) and without (A2,n = 25) adhesions up to the myocardium and TLE with the Novel R/L type (n = 142) of sheath with (B1, n = 59) and without (B2, n = 83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p = 0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p = 0.0067). There were no deaths. Overall major complication rates were low (2/185; 1.1%) and there was no statistically significant difference in major and minor complications between the two groups. Conclusion Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.
ISSN:0147-8389
1540-8159
DOI:10.1111/pace.14416