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Transvenous removal of pacing and icd leads: Single italian referral center experience.

Session Management of device complications and lead extraction: are we getting better?

Speaker Andrea Di Cori

Event : ESC Congress 2016

  • Topic : arrhythmias and device therapy
  • Sub-topic : Device Complications and Lead Extraction
  • Session type : Moderated Posters

Authors : MG Bongiorni (Pisa,IT), E Soldati (Pisa,IT), L Segreti (Pisa,IT), A Di Cori (Pisa,IT), G Zucchelli (Pisa,IT), S Viani (Pisa,IT), L Paperini (Pisa,IT), G Coluccia (Pisa,IT), F Menichetti (Pisa,IT), G Branchitta (Pisa,IT), D Andreini (Pisa,IT)

Authors:
M.G. Bongiorni1 , E. Soldati1 , L. Segreti1 , A. Di Cori1 , G. Zucchelli1 , S. Viani1 , L. Paperini1 , G. Coluccia1 , F. Menichetti1 , G. Branchitta1 , D. Andreini1 , 1University Hospital of Pisa, Cardiology Operative Unit 2 - Pisa - Italy ,

Topic(s):
Device complications and lead extraction

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 18-19

Introduction: Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center.

Methods: Since January 1997 to December 2015, we managed 2389 consecutive patients (1830 men, mean age 65.3 years) with 4374 leads (mean pacing period 72.2 months, range 1–576). PL were 3514 (1656 ventricular, 1475 atrial, 383 coronary sinus leads), DL were 860 (839 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 81% (systemic 27%, local 54%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach.

Results: Removal was attempted in 4364 leads because the technique was not applicable in 10 PL. Among these, 4270 leads were completely removed (97.8%), 45 (1.1%) partially removed, 49 (1.1%) not removed. Among 4279 exposed leads, 678 were removed by manual traction (15.8%), 3173 by mechanical dilatation using the venous entry site (74.2%), 36 by femoral approach (FA) (0.8%) and 298 by JA (7.0%). All the free-floating leads were completely removed, 25.8% by FA and 74.2% by JA. Major complications occurred in 15 cases (0.63%): cardiac tamponade (14 cases, 3 deaths), hemotorax (1 death).

Conclusions: Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.

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