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Transvenous Lead Extraction—Hot Topics in Lead Management

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Disease Prevention".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 4298

Special Issue Editor

Department of Cardiology, Medical University of Lublin, Aleje Racławickie 1, 20-059 Lublin, Poland
Interests: electrotherapy; atrial fibrillation; cardiac ablation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The total number of implantations of complex devices used in the treatment of arrhythmias and advanced heart failure is growing every year. At the same time, the number of complications related to the presence of cardiac implantable electronic devices (CIEDs) is also increasing. Transvenous lead extraction is currently the key procedure in patients with complications related to CIEDs. The effectiveness of this method is high (generally greater than 90%) and the risk of major complications is about 0.4–3.4%, with a risk of death of 0.00–1.86%. In recent years, we have observed an increase in the frequency of procedures along with an increase in the number of TLE centers. It is very important to present new experiences regarding lead extraction techniques and the organization of centers aimed at improving the safety of procedures. The exchange of experience in this area is very important in terms of improving effectiveness and minimizing complications, the most dangerous of which are related to damage to the heart and vessels. At the same time, TLE is becoming the most important element of lead management, thus increasing the role of the lead extraction as a preventive procedure. Over the years, we are observing a changing profile of indications for TLE, from the prevalence of infectious indications towards an increase in lead removal for non-infectious reasons. Patients with leads potentially threatening the development of complications, especially infectious complications, are qualified for TLE procedures in experienced electrotherapy centers. The field of lead management has not yet been analyzed in detail in the literature.

This Special Issue of International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge about transvenous lead extraction. New research papers, reviews and case reports are welcome to this Special Issue. Papers dealing with new approaches to lead management are especially welcome. We will also accept manuscripts from different disciplines, including echocardiography and other diagnostic methods used in the diagnosis of complications related to CIEDs.

Dr. Andrzej Głowniak
Guest Editor

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Keywords

  • lead and tricuspid valve
  • disparities of lead management in children and juveniles
  • significance of incomplete lead extraction
  • management of extracted lead remnant
  • rupture lead during extraction
  • renewed lead extraction
  • assessment of the extent of infection in CIED carriers
  • echocardiography in transvenous lead extraction
  • difficulties during
  • transvenous lead extraction
  • lead-related venous obstruction

Published Papers (4 papers)

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Research

16 pages, 902 KiB  
Article
Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance
Int. J. Environ. Res. Public Health 2022, 19(23), 15602; https://doi.org/10.3390/ijerph192315602 - 24 Nov 2022
Viewed by 759
Abstract
Background: Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. Methods: Retrospective analysis of a large single-center database of 3654 [...] Read more.
Background: Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. Methods: Retrospective analysis of a large single-center database of 3654 TLEs. Results: Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. Conclusions: Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction—Hot Topics in Lead Management)
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17 pages, 1320 KiB  
Article
Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients?
Int. J. Environ. Res. Public Health 2022, 19(21), 14594; https://doi.org/10.3390/ijerph192114594 - 07 Nov 2022
Cited by 2 | Viewed by 1175
Abstract
Background: Lead management in children and young adults is still a matter of debate. Methods: To assess the course of transvenous lead extraction (TLE) in adults with pacemakers implanted in childhood (CIP) we compared 98 CIP patients with a control group consisting of [...] Read more.
Background: Lead management in children and young adults is still a matter of debate. Methods: To assess the course of transvenous lead extraction (TLE) in adults with pacemakers implanted in childhood (CIP) we compared 98 CIP patients with a control group consisting of adults with pacemakers implanted in adulthood (AIP). Results: CIP patients differed from AIP patients with respect to indications for TLE and pacing history. CIP patients were four–eight times more likely to require second-line or advanced tools. Furthermore, CIP patients more often than AIP were prone to developing complications: major complications (MC) (any) 2.6 times; hemopericardium 3.2 times; severe tricuspid valve damage 4.4 times; need for rescue cardiac surgery 3.7 times. The rate of procedural success was 11% lower because of 4.8 times more common lead remnants and 3.1 times more frequent permanently disabling complications. Conclusions: Due to system-related risk factors TLE in CIP patients is more difficult and complex. TLE in CIP is associated with an increased risk of MC and incomplete lead removal. A conservative strategy of lead management, acceptable in very old patients seems to be less suitable in CIP because it creates a subpopulation of patients at high risk of major complications during TLE in the future. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction—Hot Topics in Lead Management)
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18 pages, 604 KiB  
Article
Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study
Int. J. Environ. Res. Public Health 2022, 19(21), 14184; https://doi.org/10.3390/ijerph192114184 - 30 Oct 2022
Viewed by 871
Abstract
Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure [...] Read more.
Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction—Hot Topics in Lead Management)
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16 pages, 1689 KiB  
Article
Tricuspid Valve Damage Related to Transvenous Lead Extraction
Int. J. Environ. Res. Public Health 2022, 19(19), 12279; https://doi.org/10.3390/ijerph191912279 - 27 Sep 2022
Cited by 7 | Viewed by 1087
Abstract
Background: Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. [...] Read more.
Background: Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. Methods: This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed. Results: In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1–5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE. Conclusions: Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction—Hot Topics in Lead Management)
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