Percutaneous extraction of transvenous permanent pacemaker/defibrillator leads

Abstract

Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA) and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany). Results. Lead extraction was attempted in 59 leads from 36 patients (27 men), mean ± SD age 61±5 years, with permanent pacemaker (n=25), defibrillator (n=8), or cardiac resynchronisation therapy (n=3) with a mean ± SD implant duration of 50±23 months. The indications for lead removal included pocket infection (n=23), endocarditis (n=2), and ventricular (n=10) and atrial lead dysfunction (n=1). Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4±2 minutes/lead for leads implanted <48 months (n=38) and 7±3 minutes/lead for leads implanted >48 months (n=21), P=0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe. © 2014 Stylianos Paraskevaidis et al.