Re-evaluation of Transvenous Lead Extraction with Modified Standard Technique： A Prospective Study in 229 Patients

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 33; no. 5; pp. 650 - 655
• Main Author: 褚现明 李学斌 张萍 王龙 李鼎 段江波 李冰 郭继鸿
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2013; Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China; Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China%Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing 100044, China%Department of Biology, Medical College of Qingdao University, Qingdao 266021, China
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Device Removal - methods; Electrodes, Implanted; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Pacemaker, Artificial; Prospective Studies; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - surgery; Treatment Outcome; Young Adult; 临床应用; 修订; 手术成功率; 提取; 标准技术; 萃取技术; 评估标准; 静脉; infection; complication; extraction; cardiac implantable electrical device; lead
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-013-1175-y

As new-type powered sheaths are expensive and unavailable, the standard lead extraction techniques remain the mainstay in clinical applications in many countries. The purpose of this study was to re-evaluate the clinical application of the standard lead extraction techniques and equipment, and make some procedural modifications and innovations. In our center, between January 2006 and May 2012, 229 patients （median, 66 years） who underwent lead extraction due to infection and lead malfunc- tion were registered and followed up prospectively with respect to clinical features, reasons for lead ex- traction, technical characteristics, and clinical prognosis. A total of 440 leads had to be extracted trans- venously by using special tools from 229 patients （male, 72.1%）. Vegetations 〉1 cm were detected in six patients. Locking Stylets were applied for 398 （90.5%） leads. Telescoping dilator polypropylene sheaths and counter traction technique were used for 202 （45.9%） leads due to lead adhesion, and the mean im- plant duration of the 202 leads was longer than the other 238 leads （48.9±22.6 vs. 26.6±17.8 months; P 〈0.01）. In addition, modified isolation and snare techniques were used for 56 leads （12.7%）. Minor and major procedure-related complications occurred in three （1.3%） and four （1.7%） cases respectively, in- cluding one death （0.4%）. Severe lead residue occurred in one case. Complete procedural success rate was 96.1% （423/440）, and clinical success rate was 98.9% （435/440）. The median follow-up period was 18 （1-76） months. No infection- and procedure-related death occurred in our series. Our data demon- strated that high clinical success rate of transvenous lead extraction can be guaranteed by making full use of the standard lead extraction techniques and equipment with individualized modifications.