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. 2023 Nov 17;4(12):757-764.
doi: 10.1016/j.hroo.2023.11.007. eCollection 2023 Dec.

Impact of fixation mechanism and helix retraction status on right ventricular lead extraction

Marissa Frazer  1 , Francis Phan  1 , Ryle Przybylowicz  1 , Angela Krebsbach  1 , John Dornblaser  1 , Peter M Jessel  1   2 , Castigliano Bhamidipati  1 , Frederick A Tibayan  1 , Charles A Henrikson  1
Affiliations

Impact of fixation mechanism and helix retraction status on right ventricular lead extraction

Marissa Frazer et al. Heart Rhythm O2. .

Abstract

Background: The impact of lead fixation mechanism on extractability is poorly characterized.

Objective: We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads.

Methods: A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0-9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups.

Results: Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%.

Conclusion: TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.

Keywords: Active fixation lead; Fixation mechanism; Helix retraction; Passive fixation lead; Technical difficulty; Transvenous lead extraction.

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Figures

Figure 1
Figure 1
Diagrammatic representation of additive technical extraction score components.
Figure 2
Figure 2
Technical extraction score by fixation group for (A) overall active vs passive leads and (B) active leads stratified by helix retraction status vs passive leads.
Figure 3
Figure 3
Proportion of discrete technical extraction score components by fixation group.
Figure 4
Figure 4
Adjusted odds ratios for the risk of high difficulty transvenous lead extraction with technical extraction score > 4.
See this image and copyright information in PMC

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References

    1. Maytin M., Epstein L.M. Lead extraction is preferred for lead revisions and system upgrades: when less is more. Circ Arrhythm Electrophysiol. 2010;3:413–424. - PubMed
    1. Kennergren C., Bjurman C., Wiklund R., Gäbel J. A single-centre experience of over one thousand lead extractions. Europace. 2009;11:612–617. - PMC - PubMed
    1. Akhtar Z., Sohal M., Sheppard M.N., Gallagher M.M. Transvenous lead extraction: work in progress. Eur Cardiol. 2023;18:e44. - PMC - PubMed
    1. Diemberger I., Biffi M., Martignani C., Boriani G. From lead management to implanted patient management: indications to lead extraction in pacemaker and cardioverter-defibrillator systems. Expert Rev Med Devices. 2011;8:235–255. - PubMed
    1. Levi N., Bongiorni M.G., Rav Acha M., et al. Lead fixation mechanism impacts outcome of transvenous lead extraction: data from the European Lead Extraction ConTRolled Registry. Europace. 2022;24:817–827. - PubMed

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