Lead Removal of Cardiac Implantable Electronic Device
AbstractAs more people are living longer with more significant cardiac disease,
permanent pacemakers (PPMs) and implantable cardioverter-defibrillators
(ICDs) are being inserted more frequently each year. Beginning early in the
21st century, there has also been an expansion in the indications for cardiac
implantable electronic devices (CIED, a term which includes PPMs and
ICDs), and device therapy has become more complex, frequently involving
multiple leads per patient. In turn, there will be more occasion where the
lead removal for these CIED will be necessary.
A 6 y.o. patient was incidentally found to have a fractured pacemaker lead
during during routine x-ray for his respiratory tract infection. The pacemaker
was inserted 5 years ago, indicated for the permanent total atrioventricular
block developed after total correction surgery in Tetralogy of Fallot. The
lead fracture was thought to be caused by a phenomenon known as the
subclavian crush syndrome. A transvenous lead extraction in this patient
was only partially successful, leading to a surgical removal of the remaining
lead. A new permanent pacemaker along with a new lead in the apex
was successfully inserted before the surgery.
There are different levels of recommendations on whether a lead should
be extracted or left behind. And in times where removal was needed,
new specialized tool and techniques have developed in the last decade for
the safe and successful retrieval of implanted pacemaker leads.
Cardiology Faculty of Medicine Universitas Indonesia; 2012.
Garlitski AC. Cardiac implantable electronic device lead removal. In: Basow DS, ed. UpToDate. Waltham, MA: UpToDate;
Wilkoff BL, Love CJ, Byrd CL, et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the american Heart Association (AHA). Heart rhythm: the official journal of the Heart Rhythm Society 2009;6:1085-104.
Roelke M, O’Nunain SS, Osswald S, Garan H, Harthorne
JW, Ruskin JN. Subclavian crush syndrome complicating
transvenous cardioverter defibrillator systems. Pacing and clinical electrophysiology : PACE 1995;18:973-9.
Harada Y, Katsume A, Kimata M, et al. Placement of pacemaker
leads via the extrathoracic subclavian vein guided by fluoroscopy and venography in the oblique projection. Heart and vessels 2005;20:19 -22.
Magney JE, Flynn DM, Parsons JA, et al. Anatomical mechanisms explaining damage to pacemaker leads, defibrillator leads, and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing and clinical electrophysiology : PACE 1993;16:445-57.
Love CJ, Wilkoff BL, Byrd CL, et al. Recommendations for
extraction of chronically implanted transvenous pacing and
defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing and clinical electrophysiology : PACE 2000;23:544-51.
Baddour LM, Epstein AE, Erickson CC, et al. Update on
cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010;121:458-77.
Smith MC, Love CJ. Extraction of transvenous pacing and
ICD leads. Pacing and clinical electrophysiology : PACE
Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical
study of the laser sheath for lead extraction: the total experience in the United States. Pacing and clinical electrophysiology : PACE 2002;25:804-8.
Kay GN, Brinker JA, Kawanishi DT, et al. Risks of spontaneous injury and extraction of an active fixation pacemaker lead: report of the Accufix Multicenter Clinical Study and Worldwide Registry. Circulation 1999;100:2344-52.
Cooper JM, Stephenson EA, Berul CI, Walsh EP, Epstein LM.
Implantable cardioverter defibrillator lead complications and laser extraction in children and young adults with congenital heart disease: implications for implantation and management. Journal of cardiovascular electrophysiology 2003;14:344-9.
de Bie MK, Fouad DA, Borleffs CJ, et al. Trans-venous lead
removal without the use of extraction sheaths, results of >250 removal procedures. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2012;14:112-6.
Wilkoff BL, Byrd CL, Love CJ, et al. Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. Journal of the American College of Cardiology 1999;33:1671-6.
Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK,
Kallinen LM. Deaths and cardiovascular injuries due to deviceassisted implantable cardioverter-defibrillator and pacemaker lead extraction. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing,arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2010;12:395-401.
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