Post heart transplant extraction of the abandoned fragments of pacing and defibrillation leads: Proposed management algorithm

Abstract

Background: An increasing number of patients is referred for orthotopic heart transplantation (OHT) after previous implantable cardioverter- defibrillator (ICD) or cardiac resynchronisation therapy (CRT) device implantation. Aim: To assess the rate of unsuccessful lead extractions during OHT and propose an appropriate management algorithm. Methods: The study population included 73 consecutive patients who underwent OHT in our hospital between January 2009 and December 2011. Results: In the study group, 36 (49.3%) patients previously underwent ICD (21 patients, 28.8%) or CRT (15 patients, 20.5%) implantation. In 29 patients, all previously implanted leads were completely removed during transplantation. In 7 (19.5%) patients, fragments of the leads could not be removed and were abandoned due to their adherence to the venous system, including a proximal defibrillation coil in 6 cases and a fragment of a left ventricular lead in 1 case. All abandoned lead fragments were extracted after the transplantation (10-70 days, mean 27 days) either with manual traction techniques (1 case, left ventricular lead), or with the assistance of lead extraction sheaths (6 cases, dual-coil defibrillation leads). Due to lead fracture, it was necessary to use femoral approach in 1 case. No complications of lead extraction were noted. Conclusions: In a significant number of patients, previously implanted leads cannot be removed during OHT. Therefore, abandoned lead fragments should be removed after the transplantation using transvenous lead extraction techniques. Copyright © Polskie Towarzystwo Kardiologiczne.