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Review
. 2023 Jun 19:18:e44.
doi: 10.15420/ecr.2023.06. eCollection 2023.

Transvenous Lead Extraction: Work in Progress

Zaki Akhtar  1 , Manav Sohal  1 , Mary N Sheppard  2 , Mark M Gallagher  1
Affiliations
Review

Transvenous Lead Extraction: Work in Progress

Zaki Akhtar et al. Eur Cardiol. .

Abstract

Cardiac implantable electronic devices are the cornerstone of cardiac rhythm management, with a significant number of implantations annually. A rising prevalence of cardiac implantable electronic devices coupled with widening indications for device removal has fuelled a demand for transvenous lead extraction (TLE). With advancement of tools and techniques, the safety and efficacy profile of TLE has significantly improved since its inception. Despite these advances, TLE continues to carry risk of significant complications, including a superior vena cava injury and mortality. However, innovative approaches to lead extraction, including the use of the jugular and femoral accesses, offers potential for further gains in safety and efficacy. In this review, the indications and risks of TLE are discussed while examining the evolution of this procedure from simple traction to advanced methodologies, which have contributed to a significant improvement in safety and efficacy.

Keywords: ICD extraction; Transvenous lead extraction; femoral extraction; jugular pull-through; lead extraction; tandem approach.

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Conflict of interest statement

Disclosure: MS has received a research grant from Abbott Medical. MMG has received research funding from Attune Medical, and has acted as a consultant and a paid speaker for Boston Scientific and Cook Medical; and is on the European Cardiology Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Timeline of Key Tools, Techniques and Studies in Transvenous Lead Extraction
Figure 2:
Figure 2:. Traction and Countertraction
Figure 3:
Figure 3:. The Jugular Pull-through Technique by Akhtar and Gallagher
Figure 4:
Figure 4:. The Applied Forces in Modern Transvenous Lead Extraction Demonstration of the Direction of Applied Forces During Transvenous Lead Extraction
Figure 5:
Figure 5:. Cadaveric Image Demonstrating the Binding Tissue Around Leads
See this image and copyright information in PMC

References

    1. National Institute for Cardiovascular Outcomes Research (NICOR). Am Heart J. https://www.nicor.org.uk/cardiac-rhythm-management-arrhythmia-audit/ (accessed 20 January 2023) - PubMed
    1. Byrd CL, Schwartz SJ, Hedin N. Intravascular techniques for extraction of permanent pacemaker leads. Am Heart J. 1991;101:989–97. doi: 10.1016/S0022-5223(19)36615-2. - DOI - PubMed
    1. Byrd CL, Schwartz SJ, Sivina M et al. Technique for the surgical extraction of permanent pacing leads and electrodes. Am Heart J. 1985;89:142–4. doi: 10.1016/S0022-5223(19)38860-9. - DOI - PubMed
    1. Byrd CL, Schwartz SJ, Hedin NB et al. Intravascular lead extraction using locking stylets and sheaths. Am Heart J. 1990;13:1871–5. doi: 10.1111/j.1540-8159.1990.tb06906.x. - DOI - PubMed
    1. Starck CT, Gonzalez E, Al-Razzo O et al. Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques. Am Heart J. 2020;7:1103–10. doi: 10.1093/europace/euaa103. - DOI - PMC - PubMed

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