The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications

The aim of the investigation was to study the issue of making challenging decisions concerning abandonment or removal of non-infected superfluous leads during lead revisions or cardiac implantable electronic device upgrades.

Materials and Methods. From 2010 to 2019, a total of 482 patients who had undergone cardiac implantable electronic device implantation in the past were admitted to hospital for generator replacement or lead revision. In 126 patients, 155 malfunctioning leads were found. Mean age of the patients was 59.2±16.7. Total venous occlusion was found in 10 cases of these patients. All patients were divided into two groups: extracted leads group (n=83) and abandoned leads group (n=43). The main factor which influenced our strategy was the mean age of the lead. In group 1 the mean age of the lead was 6.9±5.6 years. In group 2 it was about 12 years.

Results. Lead extraction was performed by manual traction in 69 (61.7%) leads, by lead locking device in 32 (28.5%) leads, and 11 (9.8%) leads were removed using TightRail rotating dilator sheath. In 1 case of total occlusion of the superior vena cava, we performed a video-assisted thoracoscopic lead extraction at the time of vein occlusion recanalisation and electronic device reimplantation. In abandoned leads group 3 patients had lead-related complications.

Conclusion. Transvenous lead extraction with the mean age of the lead less than 10 years is an effective and safe strategy. Preventive transvenous lead extraction of non-infected leads allows avoiding lead-related complications in the long-term period.

1. Sood N., Martin D.T., Lampert R., Curtis J.P., Parzynski C., Clancy J. Incidence and predictors of perioperative complications with transvenous lead extractions: real-world experience with National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol 2018; 11(2): e004768, https://doi.org/10.1161/circep.116.004768.
2. Hindricks G., Camm J., Merkely B., Raatikainen P., Arnar D.O. The EHRA white book. European Society of Cardiology; 2017.
3. Kusumoto F.M., Schoenfeld M.H., Wilkoff B.L., Berul C.I., Birgersdotter-Green U.M., Carrillo R., Cha Y.M., Clancy J., Deharo J.C., Ellenbogen K.A., Exner D., Hussein A.A., Kennergren C., Krahn A., Lee R., Love C.J., Madden R.A., Mazzetti H.A., Moore J.C., Parsonnet J., Patton K.K., Rozner M.A., Selzman K.A., Shoda M., Srivathsan K., Strathmore N.F., Swerdlow C.D., Tompkins C., Wazni O. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14(12): e503–e551, https://doi.org/10.1016/j.hrthm.2017.09.001.
4. Wilkoff B.L., Love C.J., Byrd C.L., Bongiorni M.G., Carrillo R.G., Crossley G.H. 3rd, Epstein L.M., Friedman R.A., Kennergren C.E., Mitkowski P., Schaerf R.H., Wazni O.M.; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009; 6(7): 1085–1104, https://doi.org/10.1016/j.hrthm.2009.05.020.
5. Halperin J.L., Levine G.N., Al-Khatib S.M., Birtcher K.K., Bozkurt B., Brindis R.G., Cigarroa J.E., Curtis L.H., Fleisher L.A., Gentile F., Gidding S., Hlatky M.A., Ikonomidis J., Joglar J., Pressler S.J., Wijeysundera D.N. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol 2016; 67(13): 1572–1574, https://doi.org/10.1016/j.jacc.2015.09.001.
6. Padmanabhan D., Kella D.K., Mehta R., Kapa S., Deshmukh A., Mulpuru S., Jaffe A.S., Felmlee J.P., Jondal M.L., Dalzell C.M., Asirvatham S.J., Cha Y.M., Watson R.E. Jr., Friedman P.A. Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads. Heart Rhythm 2018; 15(2): 228–233, https://doi.org/10.1016/j.hrthm.2017.10.022.
7. Ayvazyan S.A., Sharabrin E.G., Palagina A.A., Gorshenin K.G., Buslaeva S.I., Seregin A.A. Recanalization of veins occlusion in patients after implantation of antiarrhythmic devices. Diagnosticeskaa i intervencionnaa radiologia 2019; 13(1): 45–49.
8. Abu-El-Haija B., Bhave P.D., Campbell D.N., Mazur A., Hodgson-Zingman D.M., Cotarlan V., Giudici M.C. Venous stenosis after transvenous lead placement: a study of outcomes and risk factors in 212 consecutive patients. J Am Heart Assoc 2015; 4(8): e001878, https://doi.org/10.1161/jaha.115.001878.
9. Stoney W.S., Addlestone R.B., Alford W.C. Jr., Burrus G.R., Frist R.A., Thomas C.S. Jr. The incidence of venous thrombosis following long-term transvenous pacing. Ann Thorac Surg 1976; 22(2): 166–170, https://doi.org/10.1016/s0003-4975(10)63980-x.
10. Marcial J.M., Worley S.J. Venous system interventions for device implantation. Card Electrophysiol Clin 2018; 10(1): 163–177, https://doi.org/10.1016/j.ccep.2017.11.017.
11. Li X., Ze F., Wang L., Li D., Duan J., Guo F., Yuan C., Li Y., Guo J. Prevalence of venous occlusion in patients referred for lead extraction: implications for tool selection. Europace 2014; 16(12): 1795–1799, https://doi.org/10.1093/europace/euu124.
12. Higuchi S., Shoda M., Saito S., Kanai M., Kataoka S., Yazaki K., Yagishita D., Ejima K., Hagiwara N. Safety and efficacy of transvenous lead extractions for noninfectious superfluous leads in a Japanese population: a single-center experience. Pacing Clin Electrophysiol 2019; 42(12): 1517–1523, https://doi.org/10.1111/pace.13806.
13. Deshmukh A., Patel N., Noseworthy P.A., Patel A.A., Patel N., Arora S., Kapa S., Noheria A., Mulpuru S., Badheka A., Fischer A., Coffey J.O., Cha Y.M., Friedman P., Asirvatham S., Viles-Gonzalez J.F. Trends in use and adverse outcomes associated with transvenous lead removal in the United States. Circulation 2015; 132(25): 2363–2371, https://doi.org/10.1161/circulationaha.114.013801.
14. Zucchelli G., Di Cori A., Segreti L., Laroche C., Blomstrom-Lundqvist C., Kutarski A., Regoli F., Butter C., Defaye P., Pasquié J.L., Auricchio A., Maggioni A.P., Bongiorni M.G.; ELECTRa Investigators. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2019; 21(5): 771–780, https://doi.org/10.1093/europace/euy300.
15. Sapelnikov O.V., Kulikov A.A., Cherkashin D.I., Grishin I.R., Nikolaeva O.A., Ardus D.F., Shiryaev A.A., Akchurin R.S. Removal of electrodes of implanted systems. The state of the problem. Patologiya krovoobrashcheniya i kardiokhirurgiya 2019; 23(4): 47–52, https://doi.org/10.21688/1681-3472-2019-4-47-52.
16. Burri H. Overcoming the challenge of venous occlusion for lead implantation. Indian Pacing Electrophysiol J 2015; 15(2): 110–112, https://doi.org/10.1016/j.ipej.2015.07.006.
17. Lickfett L., Bitzen A., Arepally A., Nasir K., Wolpert C., Jeong K.M., Krause U., Schimpf R., Lewalter T., Calkins H., Jung W., Lüderitz B. Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace 2004; 6(1): 25–31, https://doi.org/10.1016/j.eupc.2003.09.001.
18. Golian M., Vo M., Ravandi A., Seifer C.M. Venoplasty of a chronic venous occlusion allowing for cardiac device lead placement: a team approach. Indian Pacing Electrophysiol J 2016; 16(6): 197–200, https://doi.org/10.1016/j.ipej.2016.11.007.
19. Witte O.A., Adiyaman A., van Bemmel M.W., Smit J.J.J., Ghani A., Misier A.R.R., Elvan A., Delnoy P.P.H.M. Mechanical power sheath mediated recanalization and lead implantation in patients with venous occlusion: technique and results. J Cardiovasc Electrophysiol 2018; 29(2): 316–321, https://doi.org/10.1111/jce.13389.
20. Bontempi L., Vassanelli F., Cerini M., Inama L., Mitacchione G., Giacopelli D. Video-assisted thoracoscopic monitoring of laser lead extraction by femoral route. Innovations (Phila) 2018; 13(3): 233–235, https://doi.org/10.1097/imi.0000000000000503.
21. Goyal S.K., Ellis C.R., Ball S.K., Ahmad R., Hoff S.J., Whalen S.P., Rottman J. High-risk lead removal by planned sequential transvenous laser extraction and minimally invasive right thoracotomy. J Cardiovasc Electrophysiol 2014; 25(6): 617–621, https://doi.org/10.1111/jce.12368.
22. Migliore F., Cavalli G., Bottio T., Testolina M., De Lazzari M., Bertaglia E., Iliceto S., Gerosa G. Hybrid minimally invasive technique with the bidirectional rotational Evolution® mechanical sheath for transvenous lead extraction: a collaboration between electrophysiologists and cardiac surgeons. J Arrhythm 2018; 34(3): 329–332, https://doi.org/10.1002/joa3.12064.
23. Kiuchi M.G., Andrade R.L.L., Silva G.R.D., Souto H.B., Chen S., Junior H.V. ICD leads extraction and clearing of access way in a patient with superior vena cava syndrome: building a tunnel. Medicine (Baltimore) 2015; 94(38): e1481, https://doi.org/10.1097/md.0000000000001481.

Ayvazyan S.A., Gamzaev A.B., Palagina A.A., Gorshenin K.G., Buslaeva S.I., Seregin A.A., Konovalov N.S., Sapelnikov O.V. The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications. Sovremennye tehnologii v medicine 2021; 13(1): 66, https://doi.org/10.17691/stm2021.13.1.08