Dr. Martin reports travel support for a lecture from St. Jude Medical; he serves on the advisory board of Medtronic. Dr. Wilkoff serves without compensation on the advisory board of Spectranetics. Other authors: No disclosures.
Cardiac Venous Left Ventricular Lead Removal and Reimplantation Following Device Infection: A Large Single-Center Experience
Article first published online: 1 AUG 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 11, pages 1213–1216, November 2012
How to Cite
RICKARD, J., TARAKJI, K., CRONIN, E., BRUNNER, M. P., JACKSON, G., BARANOWSKI, B., BOREK, P. P., MARTIN, D. O., WAZNI, O. and WILKOFF, B. L. (2012), Cardiac Venous Left Ventricular Lead Removal and Reimplantation Following Device Infection: A Large Single-Center Experience. Journal of Cardiovascular Electrophysiology, 23: 1213–1216. doi: 10.1111/j.1540-8167.2012.02392.x
- Issue published online: 13 NOV 2012
- Article first published online: 1 AUG 2012
- Manuscript received 19 April 2012; Revised manuscript received 5 May 2012; Accepted for publication 16 May 2012.
- cardiac resynchronization therapy;
- device-related infection;
- heart failure;
- lead removal;
- laser-powered sheath;
- LV lead
LV Lead Extraction and Reimplantation. Background: Early series of biventricular device removal have contained mostly younger cardiac venous (CV) left ventricular leads and few have reported on rates of successful reimplantation.
Methods and Results: We performed a retrospective analysis of all patients referred to the Cleveland Clinic between February 2, 2001 and July 27, 2011 for removal of a biventricular device with a CV pacing lead for an infectious indication. A total of 173 patients were included. The median age of the CV leads was 22.3 months (interquartile range: 5.2–46.3 months). The complete procedural success rate for all leads was 97.7%, with the remaining 2.3% clinical successes. A total of 76.9% of CV leads were removed using simple traction alone with the remaining leads requiring the use of a laser-powered sheath. A total of 3.5% of leads required intervention (manual dissection or laser-powered dissection) within the coronary sinus (CS). Major complications occurred in 1.2% of patients. Minor complications occurred in 7.5% of patients, the majority of which were hematomas requiring drainage (6.9%). CV lead reimplantation was attempted in 107 patients of which 88 (82.8%) were successful.
Conclusion: CV lead removal in patients with an infected biventricular device is associated with an extremely high procedural success rate and a low incidence of major complications. The use of a laser-powered sheath is necessary in roughly one-quarter of cases with a very small percentage requiring intervention within the CS. Reimplantation of CV leads is achievable in roughly 83% of patients, a figure lower than nationally quoted estimates for de novo implantations. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1213–1216, November 2012)