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Rinaldi CA, Diemberger I, Biffi M, Gao YR, Sizto E, Jin N, Epstein LM, Defaye P. Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients. Europace 2023; 25:euad298. [PMID: 37757839 PMCID: PMC10655058 DOI: 10.1093/europace/euad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS While numerous studies have demonstrated favourable safety and efficacy of the excimer laser sheath for transvenous lead extraction (TLE) in smaller cohorts, comprehensive large-scale investigations with contemporary data remain scarce. This study aims to evaluate the safety and performance of laser-assisted TLE through a meta-analysis of contemporary data. METHODS AND RESULTS A systematic literature search was conducted to identify articles that assessed the safety and performance of the spectranetics laser sheath (SLS) II and GlideLight Excimer laser sheaths in TLE procedures between 1 April 2016 and 31 March 2021. Safety outcomes included procedure-related death and major/minor complications. Performance outcomes included procedural and clinical success rates. A random-effects, inverse-variance-weighting meta-analysis was performed to obtain the weighted average of the evaluated outcomes. In total, 17 articles were identified and evaluated, including 1729 patients with 2887 leads. Each patient, on average, had 2.3 ± 0.3 leads with a dwell time of 7.9 ± 3.0 years. The TLE procedural successes rate was 96.8% [1440/1505; 95% CI: (94.9-98.2%)] per patient and 96.3% [1447/1501; 95% CI: (94.8-97.4%)] per lead, and the clinical success rate per patient was 98.3% [989/1010, 95% CI: (97.4-99.0%)]. The procedure-related death rate was 0.08% [7/1729, 95% CI: (0.00%, 0.34%)], with major and minor complication rates of 1.9% [41/1729; 95% CI: (1.2-2.8%)] and 1.9% [58/1729; 95% CI: (0.8-3.6%)], respectively. CONCLUSION This meta-analysis demonstrated that excimer laser sheath-assisted TLE has high success and low procedural mortality rates. It provides clinicians with a reliable and valuable resource for extracting indwelling cardiac leads which require advanced extraction techniques.
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Affiliation(s)
- Christopher Aldo Rinaldi
- Cardiovascular Department, Guy's & St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
| | - Yu-Rong Gao
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Enoch Sizto
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | - Nancy Jin
- Image Guided Therapy, Philips North America LLC, Cambridge, MA, USA
| | | | - Pascal Defaye
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
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Akhtar Z, Sohal M, Starck CT, Mazzone P, Melillo F, Gonzalez E, Al-Razzo O, Richter S, Breitenstein A, Steffel J, Rinaldi CA, Mehta V, Zuberi Z, Zaidi A, Gallagher MM. Persistent left superior vena cava transvenous lead extraction: A European experience. J Cardiovasc Electrophysiol 2021; 33:102-108. [PMID: 34783107 DOI: 10.1111/jce.15290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is rising in parallel to cardiac implantable electronic device implantations. Persistent left side superior vena cava (PLSVC) is a relatively common anatomical variant in the healthy population; TLE in patients with a PLSVC is rare. METHOD Data were collated from 6 European TLE institutes of 10 patients who had undergone lead extraction with a PLSVC. Patient demographics, procedural challenges and outcomes were reported. RESULTS Ten patients aged 73.4 ± 7.8 years (60% male) underwent TLE of 20 leads (3 left ventricle, 10 right ventricle, 7 right atrium) with dwell time of 82.95 ± 39.1 months. Of the 10 cases, 4 had an infection indication and 5 were biventricular system extractions; 25% of the extracted leads were defibrillator leads. The majority of the procedures were completed in the cardiac catheterization suite (80%) under general anaesthesia (60%) by cardiologists (80%) using a rotational powered sheath (65%). The Tandem approach was used successfully in 3 cases. Complete procedural success was obtained in 100% of cases in the absence of complications within 127.4 ± 74.7 min. There was no 30-day mortality. CONCLUSION TLE in PLSVC is feasible albeit rare. Standard extraction techniques in experienced hands are associated with favorable outcomes; the Tandem procedure may be an additional technique to improve the safety and efficacy of TLE in PLSVC.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, London, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, London, UK
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany
| | | | | | - Elkin Gonzalez
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Omar Al-Razzo
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Sergio Richter
- Department of Electrophysiology, HELIOS Heart Center-University of Leipzig, Leipzig, Germany
| | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
| | | | - Vishal Mehta
- Department of Cardiology, Guy's and St Thomas's Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, London, UK
| | - Amir Zaidi
- Department of Cardiology, Manchester University Hospitals, Manchester, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, London, UK
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Curnis A, Aboelhassan M, Cerini M, Salghetti F, Fabbricatore D, Maiolo V, Arabia G, Giacopelli D, Fouad DA, Bontempi L. Transvenous lead extraction in patients with persistent left superior vena cava. J Cardiovasc Electrophysiol 2021; 32:1407-1410. [PMID: 33783892 DOI: 10.1111/jce.15021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Predictors of difficulty and complications of transvenous lead extraction (TLE) have been investigated in several studies; however, little is known about the venous anatomical characteristics that can have an impact on procedural outcomes. Among them, the persistent left superior vena cava (PLSVC) is a common anomaly often discovered incidentally during cardiac device implantation and could raise concerns if TLE is indicated. We report technical considerations and outcomes of TLE for two patients with leads implanted via PLSVC. METHODS AND RESULTS Two cardiac implantable electronic device recipients with isolated PLSVC required TLE due to infective endocarditis in one case and lead failure in the other. In the first case, TLE procedure was performed in a hybrid operating room with minimally invasive video-assisted thoracoscopic monitoring due to the high procedural risk. Two active fixation 20-year-old pacing leads were removed with a relatively short fluoroscopy time. In the second case, we successfully extracted a single-coil active fixation lead without the need of a locking stylet or advanced extraction tools. There were no procedural complications or adverse events at 1-year follow-up. CONCLUSION TLE procedures for two patients with isolated PLSVC were successfully completed with less difficulty and tools than expected based on the characteristics of the targeted leads. If indicated, TLE in the presence of a PLSVC should be considered in experienced centers.
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Affiliation(s)
- Antonio Curnis
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | - Mohamed Aboelhassan
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy.,Assiut University Heart Hospital, Assiut, Egypt
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Vincenzo Maiolo
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Vimodrone, Italy.,Department of Cardiac, Thoracic, Vascular Science and Public Health, Padova University, Padova, Italy
| | | | - Luca Bontempi
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
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Failed laser extraction of a fractured right ventricle defibrillator lead in a patient with persistent left superior vena cava. J Vasc Access 2016; 17:e10-1. [PMID: 26450083 DOI: 10.5301/jva.5000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2015] [Indexed: 11/20/2022] Open
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Duncker D, Delnoy PP, Nägele H, Mansourati J, Mont L, Anselme F, Stengel P, Anselmi F, Oswald H, Leclercq C. First clinical evaluation of an atrial haemodynamic sensor lead for automatic optimization of cardiac resynchronization therapy. Europace 2015; 18:755-61. [PMID: 25976907 PMCID: PMC4880111 DOI: 10.1093/europace/euv114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/23/2015] [Indexed: 01/14/2023] Open
Abstract
AIMS One option to improve cardiac resynchronization therapy (CRT) responder rates lies in the optimization of pacing intervals. A haemodynamic sensor embedded in the SonRtip atrial lead measures cardiac contractility and provides a systematic automatic atrioventricular and interventricular delays optimization. This multi-centre study evaluated the safety and performance of the lead, up to 1 year. METHODS AND RESULTS A total of 99 patients were implanted with the system composed of the lead and a CRT-Defibrillator device. Patients were followed at 1, 3, 6, and 12 months post-implant. The primary safety objective was to demonstrate that the atrial lead complication free rate was superior to 90% at 3-months follow-up visit. A lead handling questionnaire was filled by implanting investigators. Lead electrical performances and the performance of the system to compute AV and VV delays were evaluated at each study visit over 1 year. The complication free rate at 3 months post-implant was 99.0% [95%CI 94.5-100.0%], P < 0.001. Electrical performances of the lead were adequate whatever the atrial lead position and remained stable over the study period. The optimization algorithm was able to compute AV and VV delays in 97% of patients, during >75% of the weeks. CONCLUSION The atrial lead is safe to implant and shows stable electrical performance over time. It therefore offers a promising tool for automatic CRT optimization to further improve responder rates to CRT.
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Affiliation(s)
- David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | | | - Herbert Nägele
- Albertinen Hospital, Süntelstr. 11a, 22457 Hamburg, Germany
| | - Jacques Mansourati
- Cardiology Department, Brest University Hospital, Boulevard Tanguy Prigent, 29609 Brest, France
| | - Lluís Mont
- Cardiology Department - Arrhythmia Section, Thorax Institute - Hospital Clinic, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - Frédéric Anselme
- Cardiology Department, Charles Nicolle University Hospital, 1 rue Germont, 76031 Rouen, France
| | - Petra Stengel
- Sorin Group Germany GmbH, Lindberghstr. 25, 80939 Munich, Germany
| | | | - Hanno Oswald
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christophe Leclercq
- Cardiology Department Pontchaillou, University Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France
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