Author + information
- Received December 12, 2018
- Revision received July 29, 2019
- Accepted July 31, 2019
- Published online December 16, 2019.
- Divyang Patel, MDa,
- Apichaya Sripariwuth, MDb,
- Mostafa Abozeed, MDb,
- Ayman A. Hussein, MDa,
- Khaldoun G. Tarakji, MD, MPHa,
- Oussama M. Wazni, MDa,
- Bruce L. Wilkoff, MDa,
- Paul Schoenhagen, MDa,b and
- Michael A. Bolen, MDa,b,∗ ()
- aDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Michael A. Bolen, Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue J1-4, Cleveland, Ohio 44195.
Objectives This study sought to retrospectively investigate outcomes of lead extraction by using pre-operative computed tomography (CT) scans to identify risk of complicated lead extraction to aid in pre-procedural planning.
Background Transvenous lead extractions remain high-risk procedures requiring specialized operators, equipment, and surgical backup. Data are lacking for how to identify difficult lead extractions. CT scans, which can illustrate the proximity of the lead to adherent venous structures can potentially aid in identifying difficult lead extractions.
Methods All cases of patients who were undergoing transvenous lead extractions at the authors’ institution between 2015 and 2018, who had a pre-operative CT scan prior to lead extraction, were reviewed. The images were retrospectively reviewed to examine adherence of leads to the surrounding vein and obtained procedural outcomes.
Results A total of 203 cases were reviewed of patients undergoing transvenous lead extraction who had a pre-operative CT scan, and scans were separated based on lead location in the superior vena cava, as assessed by CT imaging. Scans were divided into 3 groups: those in a central location or <1 cm adherence (n = 28); those that had at least 1 lead with tip adherent >1 cm (n = 137); or those that had at least 1 lead outside the vein contour (n = 38). Although there was only 1 serious complication requiring vascular surgery intervention, patients with at least 1 lead outside the vein contour required significantly longer procedural time (190.8 ± 86.6 min vs. 158.1 ± 73.7 min vs. 142.8 ± 52.2 min; p = 0.019) and fluoroscopy time (33.1 ± 24.2 min vs. 19.6 ± 18.4 min vs. 18.3 ± 16.4 min; p = 0.0006) than those with leads adhering >1 cm and centrally located leads, respectively.
Conclusions Pre-operative CT scanning can identify difficult lead extractions prior to performing the procedure. This information may aid electrophysiologists in the planning of extraction procedures. Future prospective studies are needed to confirm these findings.
Dr. Tarakji is a member of the medical advisory board for AliveCor and Medtronic. Dr. Wilkoff is a consultant for Medtronic, Abbott, and Philips Healthcare. 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 December 12, 2018.
- Revision received July 29, 2019.
- Accepted July 31, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.