Author + information
- Received March 11, 2019
- Revision received May 2, 2019
- Accepted May 3, 2019
- Published online May 29, 2019.
- Amr F. Barakat, MDa,b,∗,
- Mohammad A. Zmaili, MDa,∗,
- Khaldoun G. Tarakji, MD, MPHc,
- Shailee Shah, MDa,
- Karim Abdur Rehman, MDa,
- David O. Martin, MD, MPHc,
- Michael P. Brunner, MDc,
- Walid I. Saliba, MDc,
- Mohamed Kanj, MDc,
- Jad Ballout, MDa,
- Bryan Baranowski, MDc,
- Daniel Cantillon, MDc,
- Mark Niebauer, MD, PhDc,
- Thomas Callahan, MDc,
- Thomas Dresing, MDc,
- John Rickard, MDc,
- Bruce D. Lindsay, MDc,
- Bruce L. Wilkoff, MDc,
- Oussama M. Wazni, MDc and
- Ayman A. Hussein, MDc,∗ (, )@AmrFBarakat
- aDepartment of Medicine, Cleveland Clinic, Cleveland, OhioDepartment of Medicine, Cleveland Clinic, Cleveland, Ohio
- bHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- cCardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OhioCardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Ayman A. Hussein, Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J2.2, Cleveland, Ohio 44195.
Objectives This study aimed to evaluate the effectiveness and safety of transvenous lead extraction (TLE) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).
Background ARVC is an increasingly diagnosed cardiomyopathy that often requires device implantation to prevent sudden death. Little is known about TLE in this setting, which has potential challenges and risks, primarily due to right ventricular (RV) wall thinning and fragility.
Methods All consecutive patients with ARVC who underwent TLE at our institution between 1996 and 2016 were included. When extraction tools were used, sheaths were advanced to the RV with countertraction at the lead tip. Success and complications were defined in concordance with Heart Rhythm Society guidelines.
Results Twenty-two TLE procedures in patients with ARVC involved extraction of 27 leads (22 defibrillators and 5 pacemakers). TLEs were performed due to evidence of lead malfunction (n = 17; 77%) or device infection (n = 5; 23%). Twenty-four leads (89%) were RV, and 3 leads (11%) were right atrial. The median age of the oldest extracted lead was 1,691 days (interquartile range [IQR]: 1,168 to 2,726 days). Specialized extraction tools were required in 20 procedures (91%). None required the use of a snare or a femoral workstation. The median procedural and fluoroscopic times were 152 min (IQR: 129 to 185 min) and 11 min (IQR: 6 to 18 min), respectively. Complete procedural success with removal of all leads was achieved in all cases. There were no major complications.
Conclusions In a high-volume center, TLE in patients with ARVC was associated with a high success rate and a low rate of complications when guideline-established techniques and tools were used.
- arrhythmogenic right ventricular cardiomyopathy
- arrhythmogenic right ventricular dysplasia
- implantable cardioverter-defibrillator
- lead extraction
↵∗ Drs. Barakat and Zmaili contributed equally to this work and are joint first authors.
Dr. Tarakji has received consulting fees and honoraria from Medtronic and Spectranetics Corporation; and has been a member of the Medical Advisory Board for Medtronic and AliveCor. Dr. Cantillon has been a consultant and a member of the Steering Committee for Abbott and Boston Scientific. Dr. Callahan has been a consultant for Biotronik. Dr. Rickard has received consulting fees and honoraria from Medtronic and Abbott. Dr. Lindsay is a member of the Strategic Advisory Board and the Educational Symposium for Fellows for Medtronic. Dr. Wilkoff has been a consultant for Medtronic, Abbott, and Philips; has received fees and honoraria from St. Jude Medical, Boston Scientific Corp, Medtronic, and Spectranetics Corporation; and has received royalty income from Medtronic. Dr. Wazni has received honoraria from the Spectranetics Corporation. 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 March 11, 2019.
- Revision received May 2, 2019.
- Accepted May 3, 2019.
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