- Email: [email protected]
TRANSVENOUS LEAD EXTRACTION CAN BE PERFORMED SUCCESSFULLY IN OLDER CHILDREN AND YOUNG ADULTS
A325 JACC March 17, 2015 Volume 65, Issue 10S
Arrhythmias and Clinical EP Transvenous Lead Extraction Can Be Performed Successfully in Older Children and Young Adults Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m. Session Title: Contemporary Challenges in Cardiac Implantable Device Management Abstract Category: 6. Arrhythmias and Clinical EP: Devices Presentation Number: 1116-260 Authors: Eduard Koman, Ashwani Gupta, Faiz Subzposh, David Fridman, James McCaffrey, Heath Saltzman, Steven Kutalek, Drexel University College of Medicine, Philadelphia, PA, USA, Hahnemann University Hospital, Philadelphia, PA, USA
Background: The survival of patients with congenital anatomical and electrical heart disease is constantly increasing. Older children and young adults with cardiac implantable electronic devices are more prone to development of lead problems due to vigorous activity level, accelerated body growth and increasing lead implant duration. Lead extraction in this patient population is more challenging due to increased scar formation. We report a single center experience with transvenous lead extraction (TLE) in these patients. Methods: We evaluated patients with age ≤ 25 years who underwent TLE at our center between April 2004 and March 2014.
Results: A total of 37 patients with age ≤ 25 years underwent 40 TLE procedures (3.4% of total 1178 procedures) and 66 leads were extracted. Mean age was 20±3 years (range 12-25). 70% patients were Caucasian, 54% males, 24% had congenital heart disease, 54% had congenital electrical disorders and 32% had previous cardiac surgery. Most procedures were performed for lead malfunction (31/40) with lead fracture as the most common indication. Shock lead was extracted in 55% cases (17.5% single coil and 37.5% dual coil). Mean lead age was 80±49 months (range 7-237). Mean extraction time per lead was 27±33 minutes (range 1-181). Only 17% of the leads were extracted with manual traction and 47% patients required use of a laser. Complete lead removal was achieved in 62 out of 66 leads. There was no periprocedural or postprocedural mortality. One patient required blood transfusion due to bleeding in the pocket, one patient developed pocket hematoma and one patient developed renal failure due to sepsis. Lead age was the only statistically significant predictor for laser requirement and increased extraction time.
Conclusion: TLE can be performed successfully in older children and young adults without increased risk of periprocedural or in-patient complications. Most common indication for TLE is lead malfunction, especially lead fracture. Advanced extraction tools are required in most patients and increased lead age is the only significant predictor for use of laser.
Arrhythmias and Clinical EP Transvenous Lead Extraction Can Be Performed Successfully in Older Children and Young Adults Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m. Session Title: Contemporary Challenges in Cardiac Implantable Device Management Abstract Category: 6. Arrhythmias and Clinical EP: Devices Presentation Number: 1116-260 Authors: Eduard Koman, Ashwani Gupta, Faiz Subzposh, David Fridman, James McCaffrey, Heath Saltzman, Steven Kutalek, Drexel University College of Medicine, Philadelphia, PA, USA, Hahnemann University Hospital, Philadelphia, PA, USA
Background: The survival of patients with congenital anatomical and electrical heart disease is constantly increasing. Older children and young adults with cardiac implantable electronic devices are more prone to development of lead problems due to vigorous activity level, accelerated body growth and increasing lead implant duration. Lead extraction in this patient population is more challenging due to increased scar formation. We report a single center experience with transvenous lead extraction (TLE) in these patients. Methods: We evaluated patients with age ≤ 25 years who underwent TLE at our center between April 2004 and March 2014.
Results: A total of 37 patients with age ≤ 25 years underwent 40 TLE procedures (3.4% of total 1178 procedures) and 66 leads were extracted. Mean age was 20±3 years (range 12-25). 70% patients were Caucasian, 54% males, 24% had congenital heart disease, 54% had congenital electrical disorders and 32% had previous cardiac surgery. Most procedures were performed for lead malfunction (31/40) with lead fracture as the most common indication. Shock lead was extracted in 55% cases (17.5% single coil and 37.5% dual coil). Mean lead age was 80±49 months (range 7-237). Mean extraction time per lead was 27±33 minutes (range 1-181). Only 17% of the leads were extracted with manual traction and 47% patients required use of a laser. Complete lead removal was achieved in 62 out of 66 leads. There was no periprocedural or postprocedural mortality. One patient required blood transfusion due to bleeding in the pocket, one patient developed pocket hematoma and one patient developed renal failure due to sepsis. Lead age was the only statistically significant predictor for laser requirement and increased extraction time.
Conclusion: TLE can be performed successfully in older children and young adults without increased risk of periprocedural or in-patient complications. Most common indication for TLE is lead malfunction, especially lead fracture. Advanced extraction tools are required in most patients and increased lead age is the only significant predictor for use of laser.