Author + information
- Received February 11, 2019
- Revision received September 9, 2019
- Accepted September 12, 2019
- Published online December 16, 2019.
- Emma Svennberg, MD, PhDa,∗ (, )
- Kathleen Jacobs, MDb,
- Elliot McVeigh, PhDb,c,d,
- Victor Pretorius, MBchBe and
- Ulrika Birgersdotter-Green, MDd
- aDepartment of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet Stockholm, Sweden
- bDepartment of Radiology, University of California San Diego, San Diego, California
- cDepartment of Bioengineering, University of California San Diego, La Jolla, California
- dDivision of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
- eDivision of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
- ↵∗Address for correspondence:
Dr. Emma Svennberg, Department of Cardiology, Danderyd Hospital, Hus 18, Plan 2, SE-182 88 Stockholm, Sweden.
Objectives The aim of this study was to assess if pre-procedural computed tomography (CT) could identify high-risk operative features and predict increased procedural complexity.
Background Unpredictable lead adhesions can make lead extraction complicated. Adhesions are known to affect leads with longer indwelling time but can unpredictably affect newer leads.
Methods Consecutive patients who had CTs performed ≤90 days before their planned lead extraction (LE) were included. CTs were reviewed blinded to outcome according to a preset checklist. The outcome was a combined endpoint of procedural complexity and major complications.
Results Between January 1, 2015 and July 1, 2018, 143 patients underwent CT and LE. Median age was 68 years (interquartile range [IQR]: 54.4 to 76.5), and 35% were female. Median age of extracted leads was 111 months, and 126 (43%) were >10 years. CT detected lead perforation ≥5 mm (n = 13), <5 mm (n = 55), severe lead adhesions (n = 65), leads touching vessel wall >1 cm (n = 102), lead fracture (n = 8), and severe ipsilateral venous stenosis/occlusion (n = 36). The procedure was complex in 63 cases. There were 2 deaths, and 6 major complications. Patients with severe lead adhesions had more complex procedures (n = 36 vs 29; p = 0.04), whereas none of the other findings on CT were significantly associated with worse outcome. In patients with leads that had an indwelling time <10 years (n = 72), severe lead adhesions on CT was associated with worse outcome in multivariable analysis (odds ratio: 6.4; 95% confidence interval: 1.4 to 30.2; p = 0.02).
Conclusions Pre-procedural CT can be used to locate severe lead adhesions in patients planned for lead extraction. In patients with indwelling leads <10 years, pre-procedural CT aids in identifying patients prone to complex extractions.
- cardiac implantable electrical devices
- computed tomography
- percutaneous extraction
- preprocedural imaging
Dr. Svennberg is supported by the Stockholm County Council, Sweden (clinical post-doctoral appointment); has received financial support from the Swedish Society of Medicine, the Swedish Medical Association, and the Swedish Heart and Lung Foundation; has received institutional grants from Boehringer-Ingelheim, Carl Bennett Ltd., and Roche Diagnostics; and has received lecture fees from Bayer, Bristol-Myers Squibb-Pfizer, Boehringer-Ingelheim, and Sanofi. Prof. McVeigh has received research funding from Abbott, General Electric, Pacesetter Inc., and Tendyne; and is a shareholder of MR Interventions Inc. Dr Pretorius has received honorarium, consulting fees, and research grants from Phillips, Medtronic, and Abbott. Dr. Birgersdotter-Green has received honorarium, consulting fees, and research grants from Medtronic, Abbott, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 February 11, 2019.
- Revision received September 9, 2019.
- Accepted September 12, 2019.
- 2019 American College of Cardiology Foundation
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