Percutaneous Extraction of ePTFE-Coated ICD Leads: A Single Center Comparative Experience
Financial disclosure: Dr. Schulze has trained representatives of St. Jude Medical in device implants, is on the Speakers' Bureau of Medtronic, and has received practice development support from Boston Scientific. Dr. Horrow is an employee of AstraZeneca LP. Dr. Kutalek is a consultant for Boston Scientific and Spectranectics Co.
Address for reprints: Steven P. Kutalek, M.D., F.H.R.S., Division of Cardiology, Department of Medicine, Drexel University, College of Medicine, 245 North 15th Street, Mail Stop 470, Philadelphia, PA 19102. Fax: 215-762-3028; e-mail: email@example.com
Percutaneous extraction of standard implantable cardioverter-defibrillator leads is often complicated by ingrowth of fibrotic tissue into the shocking coils. Leads with GORE™ expanded polytetrafluoroethylene (ePTFE) coating (W. L. Gore & Associates, Inc., Newark, DE, USA) designed to inhibit fibrosis are in use, but clinical data regarding their extraction are lacking. The study's purpose was to examine the feasibility, efficacy, and safety of percutaneous extraction involving defibrillator leads coated with ePTFE.
We analyzed our database to identify all percutaneously extracted leads with ePTFE-coated shocking coils. Lead and procedure characteristics were compared to a cohort of noncoated leads of similar implant duration.
One hundred fifty-six leads were extracted from 145 patients; 57 ePTFE-coated leads, with a mean implant duration of 621 days, were extracted and compared to 99 noncoated leads, with a mean implant duration of 763 days (P = 0.0641). Mean extraction time was 5 minutes for coated leads versus 9.75 minutes for noncoated leads (P = 0.0001). Extraction time of less than 1 minute was more frequent with coated leads (61% vs 35%, P = 0.0025). Adjunct extraction tools were required less frequently with coated leads than noncoated leads (39% vs 63%, P = 0.0071). There was no fibrosis where ePTFE covered the shocking coils. Alternatively, 23 of 99 (23%) noncoated leads demonstrated fibrosis adherent to the shock coil. There were no procedure-related complications in either group.
Compared to noncoated leads, ePTFE-coated leads are associated with shorter extraction times and are less likely to require extraction tools for removal. The difference is likely related to the absence of fibrosis over the ePTFE-coated high-energy coils.