TY - JOUR
T1 - Intravascular extraction of problematic or infected permanent pacemaker leads
T2 - 1994-1996
AU - Byrd, Charles L.
AU - Wilkoff, Bruce L.
AU - Love, Charles J.
AU - Sellers, T. Duncan
AU - Turk, Kyong T.
AU - Reeves, Russell
AU - Young, Raymond
AU - Crevey, Barry
AU - Kutalek, Steven P.
AU - Freedman, Roger
AU - Friedman, Richard
AU - Trantham, Joey
AU - Watts, Michael
AU - Schutzman, John
AU - Oren, Jess
AU - Wilson, John
AU - Gold, Frank
AU - Fearnot, Neal E.
AU - Van Zandt, Heidi J.
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1999
Y1 - 1999
N2 - Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix® or Encor® leads (46%), or other causes (2%). Patients were 64 ± 17 years of age (range 5- 96); 59% were men, 41% women. Leads were implanted 47 ± 41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P < 0.0001), less experienced physicians (P < 0.0001), ventricular leads (P < 0.005), noninfected patients (P < 0.0005), and younger patients (P < 0.0001). Major complications were reported for 1.4% of patients (< 1% at centers with > 300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P < 0.005) and with less experienced physicians (P < 0.005); risk of major complications was higher for women (P < 0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.
AB - Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix® or Encor® leads (46%), or other causes (2%). Patients were 64 ± 17 years of age (range 5- 96); 59% were men, 41% women. Leads were implanted 47 ± 41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P < 0.0001), less experienced physicians (P < 0.0001), ventricular leads (P < 0.005), noninfected patients (P < 0.0005), and younger patients (P < 0.0001). Major complications were reported for 1.4% of patients (< 1% at centers with > 300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P < 0.005) and with less experienced physicians (P < 0.005); risk of major complications was higher for women (P < 0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.
KW - Infection
KW - Lead extraction
KW - Lead removal
UR - http://www.scopus.com/inward/record.url?scp=0032873111&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032873111&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.1999.tb00628.x
DO - 10.1111/j.1540-8159.1999.tb00628.x
M3 - Article
C2 - 10527016
AN - SCOPUS:0032873111
SN - 0147-8389
VL - 22
SP - 1348
EP - 1357
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 9
ER -