TECHNIQUES, SAFETY AND COMPLICATIONS OF LEFT VENTRICULAR LEAD EXTRACTION

INTRODUCTION : The implantation of coronary sinus (CS) pacemaker leads has dramatically increased over  the past few year. The experiences of  CS leads extraction  remains to be limited.
METHODS : We analysed all percutaneous extractions of transvenous CS leads performed at our institution. Extractions occurring within 1month of implantation were excluded.
RESULTS : Between 2000  and  2011, 121 CS leads were percutaneously extracted from 107 patients     ( 21 infections and 86 lead dysfunction). In 2 patient the endovasal CS lead extraction was unsuccessful. The average duration in situ for the CS Leads was 3.41 ± 2.77 years (range 2 month  –  10.1 years ). The majority of the leads were removed by simple traction ( n=87). The rest of the LV electrodes  were removed by advanced extraction techniques including  locking stylet with sheat support  (n=18), locking  stylet and laser ( n=16 ). The majority of CS leads implanted longher than  5 years required advanced extraction techniques ( 20/37, 54.3% ). There were complications with extraction of 21 leads ( 18.1 % ). Duration of implantation and method of extraction were not associated with complications, fluoroscopy time, or reimplantation success.
CONCLUSIONS : Percutaneous CS Lead extraction is successful by simple  traction alone in the majority of patients. CS leads in situ greater than 5 years, however, often require advanced techniques with cardiac surgery back-up. Advanced extraction techniques can be implemented when simple traction is unsuccessful without an appreciable  increase in complications.