Broken leads with proximal endings in the cardiovascular system: Serious consequences and extraction diffi culties

Background: Retrospective analysis of effectiveness, technical problems, and complications oftransvenous extraction of leads with the free endings migrated to the cardiovascular system (CVS).Methods: A 5-year-old database of transvenous lead extraction (TLE) procedures comprising906 patients with 1563 leads being removed was analyzed. TLE procedures of leads migratedin the CVS were compared with TLE procedures of leads with their proximal ends accessiblein the pacemaker/implantable cardioverter-defi brillator (PM/ICD) pocket.Results: In our material, the phenomenon of leads migration occurred in 5% of patients referredfor TLE and affected most frequently unipolar and atrial leads. The presence of migratingleads was associated with local venous occlusion in 64% of patients. Removal of migratingleads required other techniques than extraction of leads with their proximal ends accessible inthe PM/ICD pocket. More than 95% of migrating leads were extracted transvenously, but procedureswere signifi cantly longer. The presence of other leads made extraction of migrated leadseven more complicated. Effectiveness and complication rates for removal of migrated leads andleads accessible in the PM/ICD pocket were similar.Conclusions: We postulate that every lead migrating in the CVS should be considered forTLE. However, this extraction is technically more diffi cult and challenging than extraction ofleads accessible in the PM/ICD pocket

Percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery

We describe a case of percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery. The procedure was performed from two accesses; from the lower one (femoral) and then, due to technical problems, from the upper one (subclavian). In the last stage the flattened Dotter’s basket was introduced to the heart inside the Byrd dilator and then fastened to the described lead as the external ‘splint’. This solution is an alternative to the recommended use of the internal metal leader with anchoring function in case of significant malformation of the internal lumen of the lead. The procedure we describe is an example of the sort of individual, original solution indispensable for the efficient and safe removal of untypically displaced leads

Perforacje jam serca przez elektrody rozruszników i kardiowerterów-defibrylatorów. Doświadczenia własne w diagnostyce, leczeniu i metodach prewencji

Cardiac chamber perforation is an uncommon, but potentially dangerous, complication of implantation of a pacemaker (PM) or a cardioverter-defibrillator (ICD). Different clinical presentations are related to the time between implantation and perforation, localisation of the perforation and concomitant lesions in neighbouring organs. Diagnosis is based on concomitant analysis of the clinical picture, ECG tracings, PM or ICD function check-up with a programmer, and review of echocardiographic, X-ray and computed tomography pictures. We analysed seven cases of perforation. Perforating leads were removed in all cases and a new pacing system was implanted in five cases. Choice of operative technique (unscrewing and direct traction from device pocket, Cook system or surgical procedure with pericardial drainage) depended on the time elapsing between implantation and perforation, the presence of lesions of other organs, and the amount of fluid in the pericardial sac. Avoiding unsafe localisation of a pacing electrode in the apex and free wall of the right ventricle and in the free anterolateral wall of the right atrium, and avoiding leaving an extra length of pacing lead under tension and overscrewing of the lead helix seem to be the best ways of prevention

Percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery

We describe a case of percutaneous removal of endocardial implantable cardioverter-defibrillator lead displaced to the right pulmonary artery. The procedure was performed from two accesses; from the lower one (femoral) and then, due to technical problems, from the upper one (subclavian). In the last stage the flattened Dotter’s basket was introduced to the heart inside the Byrd dilator and then fastened to the described lead as the external ‘splint’. This solution is an alternative to the recommended use of the internal metal leader with anchoring function in case of significant malformation of the internal lumen of the lead. The procedure we describe is an example of the sort of individual, original solution indispensable for the efficient and safe removal of untypically displaced leads. (Cardiol J 2010; 17, 3: 293-298

Percutaneous extraction of a coiled, 20-year-old lead in a patient with cardiac resynchronization therapy

A 61-year-old patient with a 20-year history of permanent pacemaker implantation and half-a-year cardiac resynchronization therapy using a left ventricular lead placed via surgical approach was admitted for extraction of an old coiled right ventricular lead, which triggered ventricular arrhythmia and created a risk of pulmonary embolism. The lead was extracted via the left femoral vein in two stages: untying a loop on the lead using a pig-tail catheter and Dotter basket followed by traction and dissection of adhesions using a Byrd dilator sheath. Dissection of the old lead from the active right ventricular one posed special technical problems

Safety and effectiveness of transvenous lead extraction in elderly patients

Background: There is a considerable controversy regarding safety of transvenous lead extraction (TLE) in elderly patients due to their potentially worse general condition, more concomitant diseases, more difficult sedation or analgesia. Moreover, the present experience is not relevant. The aim of the study was the comparison of safety and feasibility of TLE in elderly and middle-aged patients.Methods: We have extracted an ingrown pacemaker (PM)/implantable cardioverter-defibrillator (ICD) leads from 1,060 adult patients (21–70 years) and 192 octogenarians (mean age 83.4 ± 3.1 years) using standard mechanical systems within the last 7 years. We compared effectiveness and complications of the TLE procedures in the two mentioned groups of patients.Results: There were more women in octogenarians referred for TLE (45.3% vs. 36.9%). In addition, more pocket infections (37.0% vs. 24.5%), less non-infective indications for PM (46.9% vs. 57.7%) and ICD systems (7.3% vs. 28.8%) TLE were observed in this group. Leads body dwelling time was similar (76.4 ± 56.8 vs. 83.5 ± 63.0) in both groups. Procedure efficacy (full radiological success 97.4% vs. 94.6%, partial radiological success 2.6% vs. 4.34%), safety measures (major complications 1.6% vs. 1.51%, minor complications 1.0% vs. 1.9%) were similar in both compared groups.Conclusions: Old age does not influence TLE effectiveness. Therefore, TLE can be safely and successfully performed in octogenarians

Zapalenie wsierdzia w prawych jamach serca u pacjenta z rozrusznikiem/ /kardiowerterem-defibrylatorem serca - niedoceniony problem diagnostyczny i leczniczy

W niniejszej pracy przedstawiono poglądy na temat zapalenia wsierdzia w prawych jamach serca u chorych z rozrusznikiem (PM)/kardiowerterem-defibrylatorem (ICD). Wskazano na konieczność diagnostyki tego schorzenia u każdego pacjenta z PM/ICD z objawami schorzeń pulmonologicznych, podkreślając znaczenie echokardiografii przezprzełykowej. Leczeniem z wyboru jest antybiotykoterapia i usunięcie układu PM/ICD. Autorzy, wskazując na doświadczenia własne z 220 przezżylnych usunięć, jako metody alternatywnej do zabiegów kardiochirurgicznych, proponują stosowanie koszyczka Dottera zabezpieczającego krążenie płucne przy usuwaniu elektrod z wegetacjami większymi niż 2 cm. Ta ostatnia sugestia wymaga jednak przeprowadzenia dalszych obserwacji

Percutaneous extraction of a coiled, 20-year-old lead in a patient with cardiac resynchronization therapy

A 61-year-old patient with a 20-year history of permanent pacemaker implantation and half- -a-year cardiac resynchronization therapy using a left ventricular lead placed via surgical approach was admitted for extraction of an old coiled right ventricular lead, which triggered ventricular arrhythmia and created a risk of pulmonary embolism. The lead was extracted via the left femoral vein in two stages: untying a loop on the lead using a pig-tail catheter and Dotter basket followed by traction and dissection of adhesions using a Byrd dilator sheath. Dissection of the old lead from the active right ventricular one posed special technical problems