14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-181

Management of difficult cases of lead extraction

Maria Grazia Bongiorni, Ezio Soldati, Giuseppe Arena, Gherardo Gherarducci, Massimo Ratti, Mario Mariani.
Interventional Arrhythmology Unit, Cardiothoracic Department, Cisanello Hospital, Pisa, Italy

Introduction

Since their introduction in the clinical practice the techniques for transvenous lead removal have improved the success rate and decreased the risk of serious complications. Today a very high success rate (about 97%) and a low incidence of serious complications (less than 2% in most reports) can be expected in Centers with a large experience about lead removal^1-3. These satisfactory results have therefore changed the management of infected or abandoned pacing and defibrillating leads^4-6.

A very high success rate, however, does not mean that transvenous lead removal is an easy procedure. Every single patient and lead are a unique case, in which the combination of both clinical and technical factors plays an important role, affecting easiness of removal, approach of the procedure, results and complications⁷.

In our opinion, transvenous lead removal cannot be considered a “standard” technique provided of a well established procedure in all the situations, but, on the contrary, a procedure in which different tools and approaches must be tailored to different conditions. Difficult cases are those where the combination of the many different features reduces the use and/or the effectiveness of the removal technique, and where a particular approach must be planned.

Transvenous lead removal can be synthetized in: – to hold the lead to remove, – to make it free by dilating adhaerences until the tip, – finally to retreive it through a vascular approach; all the factor affecting these operations can play a role in a removal procedure.

Many factors must be therefore considered in order to evaluate each case; some of them are related to the physical characteristics of the leads or to previous attempts to remove them, while others are related to the clinical conditions for pacing complications. Particular approaches can be affected by higher difficulty, longer procedural time, higher risk of complications⁸.

The management of difficult cases therefore requires both the evaluation of all the conditions affecting lead removal and the availability of effective solutions for the manifold situations.