Elsevier

Heart Rhythm

Volume 20, Issue 7, July 2023, Pages 976-981
Heart Rhythm

Clinical
Devices
Utility of a multipurpose catheter for transvenous extraction of old broken leads: A novel technique for fragile leads

https://doi.org/10.1016/j.hrthm.2023.03.209Get rights and content
Under a Creative Commons license
open access

Background

Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system and injury to the veins or heart, have been reported.

Objective

The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported.

Methods

In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction.

Results

Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted.

Conclusion

All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.

Keywords

Complication
Device extraction
Multipurpose catheter
Nonfunctional lead
Success rate

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Funding Sources: This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosures: The authors have no conflicts of interest to disclose.

1

Dr Ayako Okada and Dr Satoshi Higuchi contributed equally to this work.