Skip to main content
NCBI home page
Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2004 Mar;12(3):93–100.

Reflections of six years of lead extraction: influence on indications and technique

FA Bracke, A Meijer, B van Gelder
PMCID: PMC2497050  PMID: 25696305

Abstract

Background

Endovascular techniques have become the standard approach for extraction of pacemaker and ICD leads. However, with experience, the indications and technical approach have evolved.

Indications

In a population referred for lead extraction, we could not found a relation between the number of leads implanted and the incidence of occlusion of the access vein. Moreover, there is evidence that the lead extraction itself is accompanied with an increased risk of post-procedural venous occlusion. Electrical interference can be avoided in most cases, even in ICD patients. As complications of extraction have to be taken into account as well, it is therefore not in the patient's interest to extract chronically implanted non-functional superfluous leads. In contrast, lead extraction is a most effective way to cure pacemaker or ICD related infections, even if previous conservative therapy has failed. However, in patients at high risk, extraction might be deferred to attempt device saving therapy first.

Technique

Although leads can be removed with traction for almost all implant times, after six months additional tools are increasingly necessary to safely and completely extract them. No single technique suffices for all procedures: powered sheaths — as the laser sheath — and a femoral workstation with retrievers should be available when extraction is attempted.

Complications

Venous or myocardial perforation is a life-threatening complication of lead extraction. In these circumstances, time lacks to safely transfer a patient for emergency surgery and therefore the only safe environment to perform lead extraction is the operating theatre with cardiosurgical standby.

Keywords: indications, infection, lead extraction, nonfunctional leads

Full text

PDF
93

Images in this article

94Figure 1
on p.94
95Figure 2
on p.95
96Figure 3
on p.96
97Figure 4
on p.97
97Figure 5
on p.97
97Figure 6
on p.97
97Figure 7
on p.97
98Figure 8
on p.98
99Figure 9
on p.99

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alt E., Neuzner J., Binner L., Göhl K., Res J. C., Knabe U. H., Zehender M., Reinhardt J. Three-year experience with a stylet for lead extraction: a multicenter study. Pacing Clin Electrophysiol. 1996 Jan;19(1):18–25. doi: 10.1111/j.1540-8159.1996.tb04786.x. [DOI] [PubMed] [Google Scholar]
  2. Bracke F. A. L. E., Meijer A., Van Gelder L. M. Malfunction of endocardial defibrillator leads and lead extraction: where do they meet? Europace. 2002 Jan;4(1):19–24. doi: 10.1053/eupc.2001.0202. [DOI] [PubMed] [Google Scholar]
  3. Bracke F. A., Meijer A., Van Gelder B. Learning curve characteristics of pacing lead extraction with a laser sheath. Pacing Clin Electrophysiol. 1998 Nov;21(11 Pt 2):2309–2313. doi: 10.1111/j.1540-8159.1998.tb01172.x. [DOI] [PubMed] [Google Scholar]
  4. Bracke F. A., Meijer A., Van Gelder L. M. Symptomatic occlusion of the access vein after pacemaker or ICD lead extraction. Heart. 2003 Nov;89(11):1348–1349. doi: 10.1136/heart.89.11.1348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bracke F. A., Meijer A., van Gelder L. M. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart. 2001 Mar;85(3):254–259. doi: 10.1136/heart.85.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bracke F. A. Optimal environment for pacemaker and implantable cardioverter-defibrillator lead extraction with a laser sheath. Am J Cardiol. 1999 Jun 1;83(11):1594–1594. [PubMed] [Google Scholar]
  7. Bracke F. A., van Gelder B., Meijer A. Arteriovenous fistula after injury of the left internal mammary artery during extraction of pacemaker leads with a laser sheath. Pacing Clin Electrophysiol. 1999 May;22(5):833–834. doi: 10.1111/j.1540-8159.1999.tb00556.x. [DOI] [PubMed] [Google Scholar]
  8. Bracke Frank, Meijer Albert, Van Gelder Berry. Extraction of pacemaker and implantable cardioverter defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools. Pacing Clin Electrophysiol. 2002 Jul;25(7):1037–1040. doi: 10.1046/j.1460-9592.2002.01037.x. [DOI] [PubMed] [Google Scholar]
  9. Bracke Frank, Meijer Albert, Van Gelder Berry. Venous occlusion of the access vein in patients referred for lead extraction: influence of patient and lead characteristics. Pacing Clin Electrophysiol. 2003 Aug;26(8):1649–1652. doi: 10.1046/j.1460-9592.2003.t01-1-00247.x. [DOI] [PubMed] [Google Scholar]
  10. Byrd C. L., Schwartz S. J., Hedin N. Lead extraction. Indications and techniques. Cardiol Clin. 1992 Nov;10(4):735–748. [PubMed] [Google Scholar]
  11. Byrd C. L., Wilkoff B. L., Love C. J., Sellers T. D., Turk K. T., Reeves R., Young R., Crevey B., Kutalek S. P., Freedman R. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol. 1999 Sep;22(9):1348–1357. doi: 10.1111/j.1540-8159.1999.tb00628.x. [DOI] [PubMed] [Google Scholar]
  12. Byrd Charles L., Wilkoff Bruce L., Love Charles J., Sellers T. Duncan, Reiser Christopher. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol. 2002 May;25(5):804–808. doi: 10.1046/j.1460-9592.2002.t01-1-00804.x. [DOI] [PubMed] [Google Scholar]
  13. Choo M. H., Holmes D. R., Jr, Gersh B. J., Maloney J. D., Merideth J., Pluth J. R., Trusty J. Permanent pacemaker infections: characterization and management. Am J Cardiol. 1981 Sep;48(3):559–564. doi: 10.1016/0002-9149(81)90088-6. [DOI] [PubMed] [Google Scholar]
  14. Furman S., Behrens M., Andrews C., Klementowicz P. Retained pacemaker leads. J Thorac Cardiovasc Surg. 1987 Nov;94(5):770–772. [PubMed] [Google Scholar]
  15. Krishnan S. C., Epstein L. M. Initial experience with a laser sheath to extract chronic transvenous implantable cardioverter-defibrillator leads. Am J Cardiol. 1998 Nov 15;82(10):1293-5, A10. doi: 10.1016/s0002-9149(98)00620-1. [DOI] [PubMed] [Google Scholar]
  16. Lewis A. B., Hayes D. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R., Osborn M. J. Update on infections involving permanent pacemakers. Characterization and management. J Thorac Cardiovasc Surg. 1985 May;89(5):758–763. [PubMed] [Google Scholar]
  17. Molina J. E. Undertreatment and overtreatment of patients with infected antiarrhythmic implantable devices. Ann Thorac Surg. 1997 Feb;63(2):504–509. doi: 10.1016/s0003-4975(96)01033-8. [DOI] [PubMed] [Google Scholar]
  18. Myers M. R., Parsonnet V., Bernstein A. D. Extraction of implanted transvenous pacing leads: a review of a persistent clinical problem. Am Heart J. 1991 Mar;121(3 Pt 1):881–888. doi: 10.1016/0002-8703(91)90203-t. [DOI] [PubMed] [Google Scholar]
  19. Parry G., Goudevenos J., Jameson S., Adams P. C., Gold R. G. Complications associated with retained pacemaker leads. Pacing Clin Electrophysiol. 1991 Aug;14(8):1251–1257. doi: 10.1111/j.1540-8159.1991.tb02864.x. [DOI] [PubMed] [Google Scholar]
  20. Roeffel Simone, Bracke Frank, Meijer Albert, Van Gelder Berry, Van Dantzig Jan Melle, Botman Cees Joost, Peels Kathinka. Transesophageal echocardiographic evaluation of tricuspid valve regurgitation during pacemaker and implantable cardioverter defibrillator lead extraction. Pacing Clin Electrophysiol. 2002 Nov;25(11):1583–1586. doi: 10.1046/j.1460-9592.2002.01583.x. [DOI] [PubMed] [Google Scholar]
  21. Smith H. J., Fearnot N. E., Byrd C. L., Wilkoff B. L., Love C. J., Sellers T. D. Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. Pacing Clin Electrophysiol. 1994 Nov;17(11 Pt 2):2016–2020. doi: 10.1111/j.1540-8159.1994.tb03792.x. [DOI] [PubMed] [Google Scholar]
  22. Van Gelder B. M., Bracke F. A., Oto A., Yildirir A., Haas P. C., Seger J. J., Stainback R. F., Botman K. J., Meijer A. Diagnosis and management of inadvertently placed pacing and ICD leads in the left ventricle: a multicenter experience and review of the literature. Pacing Clin Electrophysiol. 2000 May;23(5):877–883. doi: 10.1111/j.1540-8159.2000.tb00858.x. [DOI] [PubMed] [Google Scholar]

Articles from Netherlands Heart Journal are provided here courtesy of Springer

RESOURCES