open access

Vol 25, No 2 (2018)
Original articles — Clinical cardiology
Published online: 2017-08-24
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Occurrence and extraction of implantable cardioverter-defibrillator leads with conductor externalization

Aleksander Maciąg, Paweł Syska, Maciej Sterliński, Agnieszka Kołodzińska, Artur Oręziak, Krzysztof Kuśmierski, Marta Marciniak-Emmons, Andrzej Przybylski, Łukasz Szumowski, Grzegorz Opolski, Hanna Szwed,
DOI: 10.5603/CJ.a2017.0100
·
Pubmed: 28840589
·
Cardiol J 2018;25(2):221-228.

open access

Vol 25, No 2 (2018)
Original articles — Clinical cardiology
Published online: 2017-08-24

Abstract

   Background: The increasing number of patients with implantable cardioverter-defibrillators (ICD) contributes to the rising number of patients qualifying for a transvenous lead extraction (TLE) due to infection, vascular or lead failure related indications. The purpose of this study was to perform a retrospective analysis of the occurrence of conductor externalization in TLE patients and to assess the success rate in the extraction of these leads. Methods: TLE procedure was performed between 2012 and 2014 of 428 electrodes in 259 patients. Out of these, 143 (33.4%) leads in 138 (52.9%) patients were ICD leads. The indications for the TLE in ICD patients were: infection in 37 patients, lead failure in 84 patients, and others in 17 patients. Conductor externalization was observed in 8 ICD leads (5.6%) in 8 (5.8%) patients. The mean dwell­ing time for externalized leads was 87.9 (55 to 132) months compared to 60.1 (3 to 246) months of the remaining 135 ICD leads (p = 0.0329). All externalized leads were successfully and completely extracted using device traction, mechanical telescopic sheaths and/or autorotational cutting sheaths. No complica­tions of lead extraction procedures were observed in 8 patients with externalization. Results: Patients with lead externalization were often in a better New York Heart Association func­tional class (I or II) compared to those in the rest of the study group (p = 0.0212). Conclusions: Conductor externalization is a rare finding in patients undergoing TLE. This occurs with different manufacturers and lead types. In this complication transvenous lead extraction with the mechanical extraction tools can be safely performed.  

Abstract

   Background: The increasing number of patients with implantable cardioverter-defibrillators (ICD) contributes to the rising number of patients qualifying for a transvenous lead extraction (TLE) due to infection, vascular or lead failure related indications. The purpose of this study was to perform a retrospective analysis of the occurrence of conductor externalization in TLE patients and to assess the success rate in the extraction of these leads. Methods: TLE procedure was performed between 2012 and 2014 of 428 electrodes in 259 patients. Out of these, 143 (33.4%) leads in 138 (52.9%) patients were ICD leads. The indications for the TLE in ICD patients were: infection in 37 patients, lead failure in 84 patients, and others in 17 patients. Conductor externalization was observed in 8 ICD leads (5.6%) in 8 (5.8%) patients. The mean dwell­ing time for externalized leads was 87.9 (55 to 132) months compared to 60.1 (3 to 246) months of the remaining 135 ICD leads (p = 0.0329). All externalized leads were successfully and completely extracted using device traction, mechanical telescopic sheaths and/or autorotational cutting sheaths. No complica­tions of lead extraction procedures were observed in 8 patients with externalization. Results: Patients with lead externalization were often in a better New York Heart Association func­tional class (I or II) compared to those in the rest of the study group (p = 0.0212). Conclusions: Conductor externalization is a rare finding in patients undergoing TLE. This occurs with different manufacturers and lead types. In this complication transvenous lead extraction with the mechanical extraction tools can be safely performed.  

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Keywords

lead extraction, defibrillation leads, conductor externalization

About this article
Title

Occurrence and extraction of implantable cardioverter-defibrillator leads with conductor externalization

Journal

Cardiology Journal

Issue

Vol 25, No 2 (2018)

Pages

221-228

Published online

2017-08-24

DOI

10.5603/CJ.a2017.0100

Pubmed

28840589

Bibliographic record

Cardiol J 2018;25(2):221-228.

Keywords

lead extraction
defibrillation leads
conductor externalization

Authors

Aleksander Maciąg
Paweł Syska
Maciej Sterliński
Agnieszka Kołodzińska
Artur Oręziak
Krzysztof Kuśmierski
Marta Marciniak-Emmons
Andrzej Przybylski
Łukasz Szumowski
Grzegorz Opolski
Hanna Szwed

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