Author + information
- Received April 4, 2017
- Revision received July 25, 2017
- Accepted July 27, 2017
- Published online February 19, 2018.
- Faris Khan, MD, MSa,∗ (, )
- Gustaf Sverina,
- Ulrika Birgersdotter-Green, MDa,
- Jennifer P. Miller, BS, BA, MBAb,
- Gautam Lalani, MDa,
- Travis Pollema, MDc and
- Victor Pretorius, MBChBc
- aSection of Electrophysiology, Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
- bCRHF, Medtronic, Mounds View, Minnesota
- cDivision of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, School of Medicine, La Jolla, California
- ↵∗Address for correspondence:
Dr. Faris Khan, Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego School of Medicine, UCSD Medical Center, 9454 Medical Center Drive, 3rd Floor, Room 3E-313, La Jolla, California 92037.
Objectives This study sought to assess the risk of collateral lead damage during cardiac implantable electronic device extraction.
Background With the increasing numbers of cardiovascular implantable electronic devices, there has been an increase in the number of percutaneous device and lead extractions. It is unknown how often collateral damage (defined as the need for unintended lead extraction, or loss of lead’s integrity or dislodgement) occurs in the planned retained leads.
Methods In this retrospective study, 108 patients who underwent incomplete cardiovascular implantable electronic device removal at the University of California, San Diego from September 2010 to September 2015 were included. The authors established the integrity of previously functioning leads at the end of each procedure as well as on follow-up visits using parameters including lead impedance change, threshold change, drop in P- or R-wave signal amplitude, or presence of lead noise.
Results Only 4 of 143 leads (2.7%) were found to have collateral damage. One right atrial (RA) lead had a clear insulation break, the second RA lead was found dislodged, and the third RA had a constant noise. The right ventricular lead was found to have a new high pacing threshold. Collateral lead age, extracted lead implantation site, collateral lead implantation site, and mode of lead extraction (laser, traction, or rotational dilator) did not have a significant correlation with the outcome of collateral lead damage.
Conclusions Lead extraction can be performed safely; however, there is a small risk of damaging adjacent leads. Close follow-up is needed, especially for the first few months, to assess for the reconnected leads’ integrity.
Ms. Miller is the senior engineering director at Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 4, 2017.
- Revision received July 25, 2017.
- Accepted July 27, 2017.
- 2018 American College of Cardiology Foundation
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