Meeting abstract

https://doi.org/10.15836/ccar2019.240

Cardiac implantable electronic devices and lead removal, single center experience

Richard Matasić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Ivica Šafradin ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Danijela Krnjić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Dubravka Milača ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Davor Radić ; University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

Abstract

Introduction: Over the past couple of decades, the use of cardiac implantable electronic devices (CIEDs)
has increased significantly. Because of that and because of increased life expectancy of patients, this
has led to an increase in the number of the device and lead complications. Consequently, there is a
growing need to perform lead removal. Today, lead removal is a specialized procedure with well-defined
indications. Indication for lead removal can be infection (infective endocarditis, pocket infection,
pocket erosion, bacteremia), lead-related (fracture, insulation defect, dislocation-if the lead cannot be
repositioned, dysfunction-for reasons other than lead fracture and insulation defect, CIED upgrade/
need for additional lead(s), perforation) and chronic pain due to a periosteal reaction1. Lead removal
can be explantation (removal of leads with a dwell time of less than 1 year and using simple traction),
extraction (removal of leads with a dwell time of more than 1 year or with the use of specialized equipment
(locking stylets, snares, cutting tools, telescoping and laser sheats) regardless of implant time)
and cardiothoracic surgical procedure.
Patients and Methods: We retrospectively analyzed the characteristics, types of devices, and indications
for lead removal in 70 patients at University Hospital Centre Zagreb between January 2014 and
July 2019.
Results: Average patient age was 67.6 years and most patients were male (74.3%). 78.6% of patients were
on anticoagulation or antiplatelet therapy, and 50% had chronic renal failure or diabetes mellitus. Two
most common indications for lead removal were lead dislocation (28 patients) and pocket infection/
erosion (20 patients). Average lead dwelling time was 27.4 months. 38 explantations, 30 extractions,
and 2 surgical removals were performed. Total of 99 leads was removed, 1.28 per procedure.
Conclusion: The procedure was successful in all patients. There was no recurrence of infection after
infected device extraction. Besides 2 cases of pericardial effusion (which were not hemodynamically
significant), no other major complication (cardiac tamponade, cardiac avulsion, SVC tear, death) were
observed.
LITE RATURE
1. Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy L, et al; ESC Scientific Document Group.2018 EHRA expert consensus statement
on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific
studies and registries: endorsed by APHRS/HRS/LAHRS. Europace. 2018 Jul 1;20(7):1217. https://doi.org/10.1093/europace/euy050
Arrhythmias and Electrophysiology
Extended Abstract

Keywords

Cardiac implantable electronic device; lead removal; device infection; extraction; explantation.

Hrčak ID:

226709

URI

https://hrcak.srce.hr/226709

Publication date:

15.10.2019.

Visits: 884 *