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European Heart Journal Advance Access originally published online on October 23, 2008
European Heart Journal 2008 29(23):2886-2893; doi:10.1093/eurheartj/ehn461
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads

Maria Grazia Bongiorni*, Ezio Soldati, Giulio Zucchelli, Andrea Di Cori, Luca Segreti, Raffaele De Lucia, Gianluca Solarino, Alberto Balbarini, Mario Marzilli and Mario Mariani

Arrhythmology Unit of CardioVascular Division, CardioThoracic Department, University Hospital, Via Paradisa 2, 56100 Pisa, Italy

Received 19 November 2007; revised 19 September 2008; accepted 29 September 2008; online publish-ahead-of-print 23 October 2008.

* Corresponding author. Tel: +39 050995333, Fax: +39 050995329, Email: m.g.bongiorni{at}med.unipi.it

Aims: The aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique.

Methods and results: We developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%).

Conclusion: Mechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.

Key Words: Lead extraction • Mechanical dilatation • Internal jugular approach


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