ISSN:
1540-8159
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Of the 400,000–500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989–1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix® or Encor® leads (46%), or other causes (2%). Patients were 64 ± 17 years of age (range 5–96); 59% were men, 41% women. Leads were implanted 47 ± 41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P 〈 0.0001), less experienced physicians (P 〈 0.0001), ventricular leads (P 〈 0.005), noninfected patients (P 〈 0.0005), and younger patients (P 〈 0.0001). Major complications were reported for 1.4% of patients (〈 1% at centers with 〉 300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P 〈 0.005) and with less experienced physicians (P 〈 0.005); risk of major complications was higher for women (P 〈 0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1540-8159.1999.tb00628.x
Permalink
