Author + information
- Received January 16, 2020
- Revision received February 19, 2020
- Accepted April 8, 2020
- Published online July 20, 2020.
- Nathalie Behar, MDa,∗ (, )
- Vincent Galand, MDa,
- Raphaël P. Martins, MD, PhDa,
- Peggy Jacon, MDb,
- Nicolas Badenco, MDc,
- Hugues Blangy, MDd,
- Christine Alonso, MDe,
- Benoit Guy-Moyat, MDf,
- Rim El Bouazzaoui, MDg,
- Alain Lebon, MDh,
- Cédric Giraudeau, MDi,
- Christelle Marquie, MDj and
- Christophe Leclercq, MD, PhDa
- aCHU Rennes, Service de Cardiologie et Maladies Vasculaires, Université de Rennes 1, CIC-IT 1414, and INSERM, U1099, Rennes, France
- bCardiology Department- University Hospital of Grenoble Alpes, CS 10217, France
- cAPHP, Hôpital Pitié Salpêtrière, Paris, France
- dCHRU Nancy, Département de Cardiologie, Vandoeuvre, France
- eAmbroise-Paré Hospital, Neuilly-sur-Seine, France
- fCHU Dupuytren, Service de Cardiologie, Limoges, France
- gUniversity Hospital of Montpellier, CHU de Montpellier, Montpellier, France
- hSaint Martin Private Hospital Center, Caen, France
- iPôle Santé Oreliance, Saran, France
- jCHU Lille, Hopital Cardiologique, Lille, France
- ↵∗Address for correspondence:
Dr. Nathalie Behar, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.
Objectives The aim of this multicenter study was to characterize the efficacy and safety of subcutaneous implantable cardioverter-defibrillators (S-ICDs) lead extraction procedures.
Background S-ICDs have been developed to limit lead-related complications inherent to transvenous ICD devices. To date, no study has specifically investigated the safety and feasibility of S-ICD lead extraction procedures.
Methods Patients requiring S-ICD lead extraction between February 1, 2014, and February 28, 2019, were retrospectively included in 10 centers. The primary endpoint of the study was procedural success, defined as the removal of all the lead and lead material from the subcutaneous space. Secondary endpoints included procedural complications and the need for specific extraction tools.
Results S-ICD lead extraction procedures were performed in 32 patients (mean age 45.7 ± 13.8 years, 75.0% men, 65.6% in primary prevention). The median time from S-ICD lead implantation was 9.3 months (5.4 to 17.5 months). The primary endpoint, that is, complete removal of the material, was achieved in 96.9% of the patients, and only 1 procedural failure occurred (3.1%). Simple traction of the S-ICD lead was successful in 19 patients (59.4%), whereas 3 patients (9.4%) needed an additional incision and 9 patients (28.1%) required mechanical sheath to remove lead adhesions around the coil. No procedure-related complications occurred. Patients with successful simple traction extraction were implanted more recently (7.1 months [2.8 to 12.2 months] vs. 16.5 months [7.5 to 20.8 months]; p = 0.04) and had less prior history of sternotomy (2 [10.5%] vs. 5 [38.5%] patients; p = 0.09).
Conclusions S-ICD lead extraction is an efficient and safe procedure, but may require some specific tools like mechanical sheath, specifically when fibrotic adhesions developed around the parasternal coil.
Drs. Behar, Blangy, and Marquie have served as consultants for Boston Scientific. Dr. Leclercq has served as a consultant to Boston Scientific. 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 January 16, 2020.
- Revision received February 19, 2020.
- Accepted April 8, 2020.
- 2020 American College of Cardiology Foundation
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