Abstract
Background
Reports of coronary sinus (CS) lead removal include small studies with short implant
durations. Procedural outcomes for mature CS leads removed with long duration implantation
are unavailable.
Objective
To examine the safety, efficacy, and clinical predictors for incomplete CS lead removal
by Transvenous Lead Extraction (TLE) in a large, long implant duration cardiac resynchronization
therapy (CRT) patient cohort.
Methods
Consecutive patients with CRT devices in the Cleveland Clinic Prospective TLE Registry
who had TLE between 2013 and 2022.
Results
CS leads, n=231, implant duration = 6.1±4.0 years, removed from 226 patients were
included, employing powered sheaths for 137 leads (59.3%). Complete CS lead success
was achieved in 95.2% of leads (n=220) and in 95.6% of patients (n=216). Major complications
occurred in 5 patients (2.2%). Patients who had the CS lead extracted 1st had significantly
higher incomplete removal rates than when the other leads were 1st removed. Multivariable
analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and
removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent
predictors of incomplete CS lead removal.
Conclusion
Complete and safe lead removal rate of long implant duration CS leads by TLE was 95%.
However, CS lead age and the order that leads were extracted were the independent
predictors of incomplete CS lead removal. Therefore, before the CS lead is extracted,
physicians should first extract the leads from the other chambers and employ powered
sheaths.
Key words
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Article info
Publication history
Accepted:
March 13,
2023
Received in revised form:
February 24,
2023
Received:
January 16,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure:
Dr. Hayashi, Dr. Younis, Dr. Baranowski, and Dr. Nakhla have nothing to declare. Dr. Callahan has received consultancy fees from Philips and Biotronik and Dr. Martin has received consultancy fees from Medtronic and Dr. Wilkoff has received research grants and/or consultancy fees from Abbott, Boston Scientific, Medtronic, Biotronik, Philips, Cook, Convatec, Xcardia.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
