Transvenous Lead Extraction - Progress in Lead Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 2289

Special Issue Editors


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Guest Editor
Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego St., 20-954 Lublin, Poland
Interests: atrial fibrillation; cardiac ablation; cardiac surgery

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Guest Editor
Department of Cardiology, Medical University of Lublin, Aleje Racławickie 1, 20-059 Lublin, Poland
Interests: electrotherapy; atrial fibrillation; cardiac ablation
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Special Issue Information

Dear Colleagues,

This Special Issue "Transvenous Lead Extraction - Progress in Lead Management" aims to provide a comprehensive overview of the advancements and challenges in the field of lead extraction for cardiac device management. It will focus on the clinical aspects, techniques, outcomes, and safety considerations associated with transvenous lead extraction procedures. Leading experts in the field will contribute original research articles, reviews, and case studies to shed light on the latest developments in this rapidly evolving area. The goal is to enhance our understanding of the best practices, patient selection criteria, and potential complications related to transvenous lead extraction, ultimately improving patient outcomes and optimizing lead management strategies.

Prof. Dr. Andrzej Tomaszewski
Dr. Andrzej Głowniak
Guest Editors

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Keywords

  • transvenous lead extraction
  • cardiac device management
  • lead removal
  • complications
  • safety considerations
  • clinical outcomes
  • patient selection criteria
  • techniques
  • device-related infections
  • lead retention
  • lead abandonment
  • procedural success rates
  • follow-up care
  • risk assessment
  • long-term implications

Published Papers (4 papers)

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Research

18 pages, 4755 KiB  
Article
Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures
by Andrzej Kutarski, Wojciech Jacheć, Marek Czajkowski, Paweł Stefańczyk, Jarosław Kosior, Łukasz Tułecki and Dorota Nowosielecka
J. Clin. Med. 2024, 13(8), 2349; https://doi.org/10.3390/jcm13082349 - 18 Apr 2024
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Abstract
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long [...] Read more.
Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction - Progress in Lead Management)
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21 pages, 9348 KiB  
Article
VDD Lead Extraction—Differences with Other Leads and Practical Tips in Management
by Andrzej Kutarski, Wojciech Jacheć, Paweł Stefańczyk, Anna Polewczyk, Jarosław Kosior and Dorota Nowosielecka
J. Clin. Med. 2024, 13(3), 800; https://doi.org/10.3390/jcm13030800 - 30 Jan 2024
Viewed by 527
Abstract
Background: VDD (atrial sensing, ventricular sensing/pacing) leads are relatively rarely implanted; therefore, experience in their extraction is very limited. We aimed to investigate whether VDD lead removal may be a risk factor for the increased complexity of transvenous lead extraction (TLE) or major [...] Read more.
Background: VDD (atrial sensing, ventricular sensing/pacing) leads are relatively rarely implanted; therefore, experience in their extraction is very limited. We aimed to investigate whether VDD lead removal may be a risk factor for the increased complexity of transvenous lead extraction (TLE) or major complications. Methods: We retrospectively analyzed 3808 TLE procedures (including 103 patients with VDD leads). Results: If TLE included VDD lead removal, procedure duration (lead dilation time) was prolonged, complicated extractions were slightly more common, and more advanced tools were required. This is partly due to longer implant duration (in patients with VDD systems—135.2 months; systems without VDD leads—109.3 months; p < 0.001), more frequent presence of abandoned leads (all systems containing VDD leads—22.33% and all systems without VDD leads—10.77%), and partly to the younger age of patients with VDD leads (51.74 vs. 57.72 years; p < 0.001, in the remaining patients) at the time of system implantation. VDD lead extraction does not increase the risk of major complications (1.94 vs. 2.34%; p = 0.905). Conclusions: The extraction of VDD leads may be considered a risk factor for increased procedure complexity, but not for major complications. However, this is not a direct result of VDD lead extraction but specific characteristics of the patients with VDD leads. Operator skill and team experience combined with special custom maneuvers can enable favorable results to be achieved despite the specific design of VDD leads, even with older VDD lead models. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction - Progress in Lead Management)
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14 pages, 1476 KiB  
Article
LECOM (Lead Extraction COMplexity): A New Scoring System for Predicting a Difficult Procedure
by Wojciech Jacheć, Dorota Nowosielecka, Bettina Ziaja, Anna Polewczyk and Andrzej Kutarski
J. Clin. Med. 2023, 12(24), 7568; https://doi.org/10.3390/jcm12247568 - 08 Dec 2023
Cited by 2 | Viewed by 617
Abstract
(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis [...] Read more.
(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis of 3741 TLE procedures with and without complicating factors (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a five-point Complex Indicator of Difficulty of (TLE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicate a higher level of procedure complexity. (3) Results: Patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous procedures, passive fixation and multiple leads to be extracted, and a ratio of dwell time of oldest lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrates that a point total (being the sum of the odds ratios of the above variables) of >9.697 indicates a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, a logistic function was calculated, and we constructed a simple equation for lead extraction complexity that can predict the probability of a difficult procedure. The risk of complex extraction (as a percentage) is calculated as [1/(1 + 55.34 · 0.754X)] · 100 (p < 0.001). (4) Conclusion: The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction - Progress in Lead Management)
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11 pages, 1597 KiB  
Article
Novel Hematological Parameters in the Assessment of the Extent of Cardiac Implantable Electronic Device-Related Infections
by Maciej Polewczyk, Wojciech Jacheć, Dorota Szczęśniak-Stańczyk, Anna Polewczyk, Andrzej Tomaszewski, Wojciech Brzozowski, Dorota Nowosielecka and Andrzej Kutarski
J. Clin. Med. 2023, 12(23), 7498; https://doi.org/10.3390/jcm12237498 - 04 Dec 2023
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Abstract
Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, ranging from local pocket infection (PI) to lead-related infectious endocarditis (LRIE) infection spreading along the leads to the endocardium. The detection of isolated LRIE [...] Read more.
Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, ranging from local pocket infection (PI) to lead-related infectious endocarditis (LRIE) infection spreading along the leads to the endocardium. The detection of isolated LRIE and the assessment of the spread of infection in a patient with PI is often difficult and requires complex imaging and microbiological tests. The aim of the current study is to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED, differentiating vegetation and vegetation-like masses, and assessing the extent of infections in patients with PI. Methods: A retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006–2020, was conducted. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), and lymphocyte-to-platelet ratio (LPR) in the diagnosis of CIED infections, evaluate the spread of the infectious process in patients with PI and differentiate additional structures related to the presence of lead. Results: The values of NLR and NPR were significantly higher in infectious patients than non-infectious controls (3.07 vs. 2.59; p < 0.001, and 0.02 vs. 0.01; p = 0.008) and the area under the ROC curve (AUC) was 0.59; p < 0.001 and 0.56; p < 0.001, respectively. The high specificity of the new markers in detecting the infectious process was demonstrated: 72.82% for NLR (optimal cut-off value: 3.06) and 79.47% for NPR (optimal cut off value: 0.02). The values of NLR and NPR were significantly higher in patients with vegetations than in non-infectious patients with the presence of additional lead-related masses (3.37 vs. 2.61; p < 0.001 and 0.03 vs. 0.02; p = 0.008). The AUC of NLR and NPR for the prediction of vegetations was 0.65; p < 0.001 and 0.60; p < 0.001 with the highest specificity of NPR (82.78%) and an optimal cut-off value of 0.03. NLR and NPR were higher in patients with LRIE compared to isolated PI (4.11 vs. 2.56; p < 0.001 and 0.03 vs. 0.02; p < 0.001) and the ROC curve analysis for coexistence LRIE with PI showed the AUC for NLR: 0.57; p < 0.001 and AUC for NPR: 0.55; p = 0.001. High specificity in the detection of coexistence between PI and LRIE was demonstrated for NLR (87.33%), with an optimal cut-off value of 3.13. Conclusions: Novel hematological markers (NLR and NPR) are characterized by high specificity in the initial diagnosis of CIED infections, with optimal cut-off values of 3.06 and 0.02. NLR is also useful in the assessment of the spread of infection in patients with PI, with a calculated optimal cut-off value of 3.13. NPR may be helpful in the differentiation of vegetation and vegetation-like masses with an optimal cut-off value of 0.03. Full article
(This article belongs to the Special Issue Transvenous Lead Extraction - Progress in Lead Management)
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