Post heart transplant extraction of the abandoned fragments of pacing and defibrillation leads: proposed management algorithm

Abstract

Background: An increasing number of patients is referred for orthotopic heart transplantation (OHT) after previous implantable
cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT) device implantation.

Aim: To assess the rate of unsuccessful lead extractions during OHT and propose an appropriate management algorithm.
Methods: The study population included 73 consecutive patients who underwent OHT in our hospital between January
2009 and December 2011.

Results: In the study group, 36 (49.3%) patients previously underwent ICD (21 patients, 28.8%) or CRT (15 patients, 20.5%)
implantation. In 29 patients, all previously implanted leads were completely removed during transplantation. In 7 (19.5%)
patients, fragments of the leads could not be removed and were abandoned due to their adherence to the venous system,
including a proximal defibrillation coil in 6 cases and a fragment of a left ventricular lead in 1 case. All abandoned lead fragments
were extracted after the transplantation (10–70 days, mean 27 days) either with manual traction techniques (1 case, left
ventricular lead), or with the assistance of lead extraction sheaths (6 cases, dual-coil defibrillation leads). Due to lead fracture,
it was necessary to use femoral approach in 1 case. No complications of lead extraction were noted.

Conclusions: In a significant number of patients, previously implanted leads cannot be removed during OHT. Therefore,
abandoned lead fragments should be removed after the transplantation using transvenous lead extraction techniques.