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

Abstract

Many factors can affect the easiness, the safety and finally the outcome of transvenous lead removal procedures. The technical factors are related both to the physical characteristics of pacing and defibrillating leads (fixation mechanism, lead’s shape, polarity) and to particular conditions due to the damage of the lead during its life (coil fracture, insulation failure, lead damage, free-floating leads). The clinical factors are related to both the history (implant duration, multiple leads) and the interaction between patients and leads (extention and tightness of binding sites, calcified scar tissue). All these factors can adversely affect the procedure of transvenous removal. The management of difficult leads required the development of different approaches and techniques. In our Institution we developed a transvenous approach through the internal jugular vein for the management of difficult cases. The right internal jugular vein approach presents some advantages: 1) it allows exposure of most intravascular leads (once the lead is exposed, it is possible to perform the standard procedure more easily); 2) the course of the lead from the internal jugular vein and the right heart is more direct and straight, allowing easier dilation of the adherences and countertraction, and reducing the risk of complications. The internal transjugular approach was carried out in 59 patients (43 men) with a mean age of 59.2 years (range 28-93). The procedure was performed in 25 free-floating leads (8 atrial, 16 ventricular and 1 ventricular ICD lead) and 44 difficult exposed leads (6 atrial, 30 ventricular pacing leads; 1 atrial, 6 ventricular, 1 caval defibrillating leads). The mean implant period was 90.7 months (range 13-239).

The procedure was effective in 68 out of 69 leads (98.6%). Particularly all the intravascular leads and all the ICD leads were completely removed. No significant complications were observed.

The use of this innovative approach allowed to improve the success rate in presence of difficult leads. The very high effectiveness and safety suggest this approach for the management of the difficult cases of transvenous lead removal.

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