35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques
IntroductionWith increasing numbers and complexity of implantable devices, the need for lead extraction is also increasing. There is little UK data available on clinical outcomes. We compiled a multi-centre registry of patients undergoing lead extraction to investigate predictors of success and comp...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2017-06, Vol.103 (Suppl 5), p.A28-A29 |
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| creator | Martin, Claire Chooneea, Bashistraj Gajendragadkar, Parag Ahsan, Syed Begley, David Dhinoja, Mehul Earley, Mark Ezzat, Vivienne Finlay, Malcolm Grace, Andrew Heck, Patrick Hunter, Ross Lambiase, Pier Lowe, Martin Rowland, Edward Schilling, Richard Segal, Oliver Sporton, Simon Virdee, Munmohan Chow, Anthony |
| description | IntroductionWith increasing numbers and complexity of implantable devices, the need for lead extraction is also increasing. There is little UK data available on clinical outcomes. We compiled a multi-centre registry of patients undergoing lead extraction to investigate predictors of success and complications.MethodsData on all cases at three UK tertiary centres (St. Barts and The Heart Hospital London and Papworth Hospital Cambridge) were collected over 18 months. Cases where leads were >1 year in age or where specialist extraction equipment was used were included (cases=137, leads=268).Results69% of patients were male, age 66±16 years (mean±SD). Devices extracted were single chamber PPMs (5%), dual chamber PPMs (42%), CRTPs (6%), single chamber ICDs (6%), dual chamber ICDs (17%) and CRTDs (24%). 76% of ICD leads were dual coil. Number of leads extracted per patient was 2.0±1.0 and time from implantation was 8.3±11.1 years. Leads were extracted using simple traction (39%), traction with locking stylets alone (8%) or dilator sheaths (5%), bidirectional cutting sheaths (38%) or laser (10%). Only 2% of cases required additional femoral access. Specialist equipment was preferentially used for older leads (10.4±13.1 vs 5.2±5.8 years, p |
| doi_str_mv | 10.1136/heartjnl-2017-311726.35 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1906100800</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4322712697</sourcerecordid><originalsourceid>FETCH-LOGICAL-b1685-b55b4bce4abc0d5aab76a16a6ad970a6b6f1bfd1bdf709acba8a549708f8830f3</originalsourceid><addsrcrecordid>eNqNkMtKxDAUhoMoOI4-gwHX1WTSpK07GbzBgBsH3IUkTWZS22RMUnF2bnxRn8SW6t7VOZzzX-AD4ByjS4wJu9pqEVLj2myBcJERjIsFuyT0AMxwzsrx-nI47ITSjCFSHIOTGBuEUF6VbAYsod-fX-tX2PVtspnSLgUNg97YmMIeegNTEC6-a-f7CFstaqg_hpNK1rtrqFrrrBIt9H1SvtOwj9ZtYG2N0WHIgkmrrbNvvY6n4MiINuqz3zkH67vb5-VDtnq6f1zerDKJWUkzSanMpdK5kArVVAhZMIGZYKKuCiSYZAZLU2NZmwJVQklRCpoPr9KUJUGGzMHFlLsLfuxNvPF9cEMlxxViGKESoUFVTCoVfIxBG74LthNhzzHiI1f-x5WPXPnElRM6OBeTU3bNv00_C3CB_g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1906100800</pqid></control><display><type>article</type><title>35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques</title><source>PubMed Central</source><creator>Martin, Claire ; Chooneea, Bashistraj ; Gajendragadkar, Parag ; Ahsan, Syed ; Begley, David ; Dhinoja, Mehul ; Earley, Mark ; Ezzat, Vivienne ; Finlay, Malcolm ; Grace, Andrew ; Heck, Patrick ; Hunter, Ross ; Lambiase, Pier ; Lowe, Martin ; Rowland, Edward ; Schilling, Richard ; Segal, Oliver ; Sporton, Simon ; Virdee, Munmohan ; Chow, Anthony</creator><creatorcontrib>Martin, Claire ; Chooneea, Bashistraj ; Gajendragadkar, Parag ; Ahsan, Syed ; Begley, David ; Dhinoja, Mehul ; Earley, Mark ; Ezzat, Vivienne ; Finlay, Malcolm ; Grace, Andrew ; Heck, Patrick ; Hunter, Ross ; Lambiase, Pier ; Lowe, Martin ; Rowland, Edward ; Schilling, Richard ; Segal, Oliver ; Sporton, Simon ; Virdee, Munmohan ; Chow, Anthony</creatorcontrib><description>IntroductionWith increasing numbers and complexity of implantable devices, the need for lead extraction is also increasing. There is little UK data available on clinical outcomes. We compiled a multi-centre registry of patients undergoing lead extraction to investigate predictors of success and complications.MethodsData on all cases at three UK tertiary centres (St. Barts and The Heart Hospital London and Papworth Hospital Cambridge) were collected over 18 months. Cases where leads were >1 year in age or where specialist extraction equipment was used were included (cases=137, leads=268).Results69% of patients were male, age 66±16 years (mean±SD). Devices extracted were single chamber PPMs (5%), dual chamber PPMs (42%), CRTPs (6%), single chamber ICDs (6%), dual chamber ICDs (17%) and CRTDs (24%). 76% of ICD leads were dual coil. Number of leads extracted per patient was 2.0±1.0 and time from implantation was 8.3±11.1 years. Leads were extracted using simple traction (39%), traction with locking stylets alone (8%) or dilator sheaths (5%), bidirectional cutting sheaths (38%) or laser (10%). Only 2% of cases required additional femoral access. Specialist equipment was preferentially used for older leads (10.4±13.1 vs 5.2±5.8 years, p<0.001) and for ICD leads (84% vs 53%, p<0.001).The rate of major procedural adverse events (AE) leading to death or emergent surgery was 2.2%, major AEs unrelated to the procedure was 5.8% and minor AEs was 8.7%. Predictors of AEs include patient age (77±28 vs 66±15 years, p=0.05), the age but not type or number of lead (14.8±24.5 vs 7.2±6.0 years, p=0.01), systemic infectiona(31 vs 8%, p<0.001), increased creatinine level (142±111 vs 108±23 µmol/L, p=0.011), decreased haemoglobin level (109±23 vs 123±24 g/L, p=0.001) and use of assisted traction or laser over simple traction or mechanical cutting sheathsb (p=0.001) – see Table. Complete extraction was achieved in 95.5% of leads, with only 2.2% with >4 cm of lead remaining in situ. Predictors of procedural failure include age but not type or number of leads (11.1±8.6 vs 8.3±11.3 years, p=0.05), systemic infectionc(24 vs 3%, p<0.001) and increased creatinine (162±126 vs 108±66 µmol/L, p=0.012). Laser extraction resulted in 100% success in removing leads. Gender, procedure duration, fluoroscopy time and dose, use of general anaesthesia or temporary pacing was independent of extraction technique and outcome.DiscussionThis is the first UK prospective multi-centre study of lead extraction data comparing extraction techniques. Overall there is a low major complication and high success rate with the use of either simple traction or specialist equipment. From our findings, high risk cases can be identified pre-procedure to allow adequate case planning. Laser extraction is clinically effective but is associated with a higher complication rates compared with mechanical cutting sheaths.Abstract 35 Table 1Uncomplicated extraction (%)Major AE due to procedure (%)Major AE not due to procedure (%)Minor AE (%)Procedural failure (%)>4 cm lead remaining (%) Reason extractedPocket infection59 (87)0 (0)0 (0)9 (13)2 (3)2 (3)Box erosion43 (86)3 (6)0 (0)4 (8)1 (2)0 (0)Systemic infection36 (69) a 0 (0)6 (12) a 10 (19) a 5 (24) c 0 (0)Lead failure72 (90)2 (3)0 (0)6 (8)4 (2)4 (2)Other17 (94)0 (0)0 (0)1 (6)0 (0)0 (0)TechniqueSimple traction97 (92)3 (3)2 (2)3 (3)2 (2)1 (1)Assisted traction26 (70) b 0 (0)1 (3)10 (27) b 3 (8)2 (5)Cutting sheath91 (91)0 (0)3 (3)7 (7)7 (7)3 (3)Laser18 (72) b 2 (8)b0 (0)5 (20) b 0 (0)0 (0)</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2017-311726.35</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><ispartof>Heart (British Cardiac Society), 2017-06, Vol.103 (Suppl 5), p.A28-A29</ispartof><rights>2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2017 (c) 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Martin, Claire</creatorcontrib><creatorcontrib>Chooneea, Bashistraj</creatorcontrib><creatorcontrib>Gajendragadkar, Parag</creatorcontrib><creatorcontrib>Ahsan, Syed</creatorcontrib><creatorcontrib>Begley, David</creatorcontrib><creatorcontrib>Dhinoja, Mehul</creatorcontrib><creatorcontrib>Earley, Mark</creatorcontrib><creatorcontrib>Ezzat, Vivienne</creatorcontrib><creatorcontrib>Finlay, Malcolm</creatorcontrib><creatorcontrib>Grace, Andrew</creatorcontrib><creatorcontrib>Heck, Patrick</creatorcontrib><creatorcontrib>Hunter, Ross</creatorcontrib><creatorcontrib>Lambiase, Pier</creatorcontrib><creatorcontrib>Lowe, Martin</creatorcontrib><creatorcontrib>Rowland, Edward</creatorcontrib><creatorcontrib>Schilling, Richard</creatorcontrib><creatorcontrib>Segal, Oliver</creatorcontrib><creatorcontrib>Sporton, Simon</creatorcontrib><creatorcontrib>Virdee, Munmohan</creatorcontrib><creatorcontrib>Chow, Anthony</creatorcontrib><title>35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques</title><title>Heart (British Cardiac Society)</title><description>IntroductionWith increasing numbers and complexity of implantable devices, the need for lead extraction is also increasing. There is little UK data available on clinical outcomes. We compiled a multi-centre registry of patients undergoing lead extraction to investigate predictors of success and complications.MethodsData on all cases at three UK tertiary centres (St. Barts and The Heart Hospital London and Papworth Hospital Cambridge) were collected over 18 months. Cases where leads were >1 year in age or where specialist extraction equipment was used were included (cases=137, leads=268).Results69% of patients were male, age 66±16 years (mean±SD). Devices extracted were single chamber PPMs (5%), dual chamber PPMs (42%), CRTPs (6%), single chamber ICDs (6%), dual chamber ICDs (17%) and CRTDs (24%). 76% of ICD leads were dual coil. Number of leads extracted per patient was 2.0±1.0 and time from implantation was 8.3±11.1 years. Leads were extracted using simple traction (39%), traction with locking stylets alone (8%) or dilator sheaths (5%), bidirectional cutting sheaths (38%) or laser (10%). Only 2% of cases required additional femoral access. Specialist equipment was preferentially used for older leads (10.4±13.1 vs 5.2±5.8 years, p<0.001) and for ICD leads (84% vs 53%, p<0.001).The rate of major procedural adverse events (AE) leading to death or emergent surgery was 2.2%, major AEs unrelated to the procedure was 5.8% and minor AEs was 8.7%. Predictors of AEs include patient age (77±28 vs 66±15 years, p=0.05), the age but not type or number of lead (14.8±24.5 vs 7.2±6.0 years, p=0.01), systemic infectiona(31 vs 8%, p<0.001), increased creatinine level (142±111 vs 108±23 µmol/L, p=0.011), decreased haemoglobin level (109±23 vs 123±24 g/L, p=0.001) and use of assisted traction or laser over simple traction or mechanical cutting sheathsb (p=0.001) – see Table. Complete extraction was achieved in 95.5% of leads, with only 2.2% with >4 cm of lead remaining in situ. Predictors of procedural failure include age but not type or number of leads (11.1±8.6 vs 8.3±11.3 years, p=0.05), systemic infectionc(24 vs 3%, p<0.001) and increased creatinine (162±126 vs 108±66 µmol/L, p=0.012). Laser extraction resulted in 100% success in removing leads. Gender, procedure duration, fluoroscopy time and dose, use of general anaesthesia or temporary pacing was independent of extraction technique and outcome.DiscussionThis is the first UK prospective multi-centre study of lead extraction data comparing extraction techniques. Overall there is a low major complication and high success rate with the use of either simple traction or specialist equipment. From our findings, high risk cases can be identified pre-procedure to allow adequate case planning. Laser extraction is clinically effective but is associated with a higher complication rates compared with mechanical cutting sheaths.Abstract 35 Table 1Uncomplicated extraction (%)Major AE due to procedure (%)Major AE not due to procedure (%)Minor AE (%)Procedural failure (%)>4 cm lead remaining (%) Reason extractedPocket infection59 (87)0 (0)0 (0)9 (13)2 (3)2 (3)Box erosion43 (86)3 (6)0 (0)4 (8)1 (2)0 (0)Systemic infection36 (69) a 0 (0)6 (12) a 10 (19) a 5 (24) c 0 (0)Lead failure72 (90)2 (3)0 (0)6 (8)4 (2)4 (2)Other17 (94)0 (0)0 (0)1 (6)0 (0)0 (0)TechniqueSimple traction97 (92)3 (3)2 (2)3 (3)2 (2)1 (1)Assisted traction26 (70) b 0 (0)1 (3)10 (27) b 3 (8)2 (5)Cutting sheath91 (91)0 (0)3 (3)7 (7)7 (7)3 (3)Laser18 (72) b 2 (8)b0 (0)5 (20) b 0 (0)0 (0)</description><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkMtKxDAUhoMoOI4-gwHX1WTSpK07GbzBgBsH3IUkTWZS22RMUnF2bnxRn8SW6t7VOZzzX-AD4ByjS4wJu9pqEVLj2myBcJERjIsFuyT0AMxwzsrx-nI47ITSjCFSHIOTGBuEUF6VbAYsod-fX-tX2PVtspnSLgUNg97YmMIeegNTEC6-a-f7CFstaqg_hpNK1rtrqFrrrBIt9H1SvtOwj9ZtYG2N0WHIgkmrrbNvvY6n4MiINuqz3zkH67vb5-VDtnq6f1zerDKJWUkzSanMpdK5kArVVAhZMIGZYKKuCiSYZAZLU2NZmwJVQklRCpoPr9KUJUGGzMHFlLsLfuxNvPF9cEMlxxViGKESoUFVTCoVfIxBG74LthNhzzHiI1f-x5WPXPnElRM6OBeTU3bNv00_C3CB_g</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>Martin, Claire</creator><creator>Chooneea, Bashistraj</creator><creator>Gajendragadkar, Parag</creator><creator>Ahsan, Syed</creator><creator>Begley, David</creator><creator>Dhinoja, Mehul</creator><creator>Earley, Mark</creator><creator>Ezzat, Vivienne</creator><creator>Finlay, Malcolm</creator><creator>Grace, Andrew</creator><creator>Heck, Patrick</creator><creator>Hunter, Ross</creator><creator>Lambiase, Pier</creator><creator>Lowe, Martin</creator><creator>Rowland, Edward</creator><creator>Schilling, Richard</creator><creator>Segal, Oliver</creator><creator>Sporton, Simon</creator><creator>Virdee, Munmohan</creator><creator>Chow, Anthony</creator><general>BMJ Publishing Group LTD</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>201706</creationdate><title>35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques</title><author>Martin, Claire ; Chooneea, Bashistraj ; Gajendragadkar, Parag ; Ahsan, Syed ; Begley, David ; Dhinoja, Mehul ; Earley, Mark ; Ezzat, Vivienne ; Finlay, Malcolm ; Grace, Andrew ; Heck, Patrick ; Hunter, Ross ; Lambiase, Pier ; Lowe, Martin ; Rowland, Edward ; Schilling, Richard ; Segal, Oliver ; Sporton, Simon ; Virdee, Munmohan ; Chow, Anthony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1685-b55b4bce4abc0d5aab76a16a6ad970a6b6f1bfd1bdf709acba8a549708f8830f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martin, Claire</creatorcontrib><creatorcontrib>Chooneea, Bashistraj</creatorcontrib><creatorcontrib>Gajendragadkar, Parag</creatorcontrib><creatorcontrib>Ahsan, Syed</creatorcontrib><creatorcontrib>Begley, David</creatorcontrib><creatorcontrib>Dhinoja, Mehul</creatorcontrib><creatorcontrib>Earley, Mark</creatorcontrib><creatorcontrib>Ezzat, Vivienne</creatorcontrib><creatorcontrib>Finlay, Malcolm</creatorcontrib><creatorcontrib>Grace, Andrew</creatorcontrib><creatorcontrib>Heck, Patrick</creatorcontrib><creatorcontrib>Hunter, Ross</creatorcontrib><creatorcontrib>Lambiase, Pier</creatorcontrib><creatorcontrib>Lowe, Martin</creatorcontrib><creatorcontrib>Rowland, Edward</creatorcontrib><creatorcontrib>Schilling, Richard</creatorcontrib><creatorcontrib>Segal, Oliver</creatorcontrib><creatorcontrib>Sporton, Simon</creatorcontrib><creatorcontrib>Virdee, Munmohan</creatorcontrib><creatorcontrib>Chow, Anthony</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martin, Claire</au><au>Chooneea, Bashistraj</au><au>Gajendragadkar, Parag</au><au>Ahsan, Syed</au><au>Begley, David</au><au>Dhinoja, Mehul</au><au>Earley, Mark</au><au>Ezzat, Vivienne</au><au>Finlay, Malcolm</au><au>Grace, Andrew</au><au>Heck, Patrick</au><au>Hunter, Ross</au><au>Lambiase, Pier</au><au>Lowe, Martin</au><au>Rowland, Edward</au><au>Schilling, Richard</au><au>Segal, Oliver</au><au>Sporton, Simon</au><au>Virdee, Munmohan</au><au>Chow, Anthony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques</atitle><jtitle>Heart (British Cardiac Society)</jtitle><date>2017-06</date><risdate>2017</risdate><volume>103</volume><issue>Suppl 5</issue><spage>A28</spage><epage>A29</epage><pages>A28-A29</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>IntroductionWith increasing numbers and complexity of implantable devices, the need for lead extraction is also increasing. There is little UK data available on clinical outcomes. We compiled a multi-centre registry of patients undergoing lead extraction to investigate predictors of success and complications.MethodsData on all cases at three UK tertiary centres (St. Barts and The Heart Hospital London and Papworth Hospital Cambridge) were collected over 18 months. Cases where leads were >1 year in age or where specialist extraction equipment was used were included (cases=137, leads=268).Results69% of patients were male, age 66±16 years (mean±SD). Devices extracted were single chamber PPMs (5%), dual chamber PPMs (42%), CRTPs (6%), single chamber ICDs (6%), dual chamber ICDs (17%) and CRTDs (24%). 76% of ICD leads were dual coil. Number of leads extracted per patient was 2.0±1.0 and time from implantation was 8.3±11.1 years. Leads were extracted using simple traction (39%), traction with locking stylets alone (8%) or dilator sheaths (5%), bidirectional cutting sheaths (38%) or laser (10%). Only 2% of cases required additional femoral access. Specialist equipment was preferentially used for older leads (10.4±13.1 vs 5.2±5.8 years, p<0.001) and for ICD leads (84% vs 53%, p<0.001).The rate of major procedural adverse events (AE) leading to death or emergent surgery was 2.2%, major AEs unrelated to the procedure was 5.8% and minor AEs was 8.7%. Predictors of AEs include patient age (77±28 vs 66±15 years, p=0.05), the age but not type or number of lead (14.8±24.5 vs 7.2±6.0 years, p=0.01), systemic infectiona(31 vs 8%, p<0.001), increased creatinine level (142±111 vs 108±23 µmol/L, p=0.011), decreased haemoglobin level (109±23 vs 123±24 g/L, p=0.001) and use of assisted traction or laser over simple traction or mechanical cutting sheathsb (p=0.001) – see Table. Complete extraction was achieved in 95.5% of leads, with only 2.2% with >4 cm of lead remaining in situ. Predictors of procedural failure include age but not type or number of leads (11.1±8.6 vs 8.3±11.3 years, p=0.05), systemic infectionc(24 vs 3%, p<0.001) and increased creatinine (162±126 vs 108±66 µmol/L, p=0.012). Laser extraction resulted in 100% success in removing leads. Gender, procedure duration, fluoroscopy time and dose, use of general anaesthesia or temporary pacing was independent of extraction technique and outcome.DiscussionThis is the first UK prospective multi-centre study of lead extraction data comparing extraction techniques. Overall there is a low major complication and high success rate with the use of either simple traction or specialist equipment. From our findings, high risk cases can be identified pre-procedure to allow adequate case planning. Laser extraction is clinically effective but is associated with a higher complication rates compared with mechanical cutting sheaths.Abstract 35 Table 1Uncomplicated extraction (%)Major AE due to procedure (%)Major AE not due to procedure (%)Minor AE (%)Procedural failure (%)>4 cm lead remaining (%) Reason extractedPocket infection59 (87)0 (0)0 (0)9 (13)2 (3)2 (3)Box erosion43 (86)3 (6)0 (0)4 (8)1 (2)0 (0)Systemic infection36 (69) a 0 (0)6 (12) a 10 (19) a 5 (24) c 0 (0)Lead failure72 (90)2 (3)0 (0)6 (8)4 (2)4 (2)Other17 (94)0 (0)0 (0)1 (6)0 (0)0 (0)TechniqueSimple traction97 (92)3 (3)2 (2)3 (3)2 (2)1 (1)Assisted traction26 (70) b 0 (0)1 (3)10 (27) b 3 (8)2 (5)Cutting sheath91 (91)0 (0)3 (3)7 (7)7 (7)3 (3)Laser18 (72) b 2 (8)b0 (0)5 (20) b 0 (0)0 (0)</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/heartjnl-2017-311726.35</doi><oa>free_for_read</oa></addata></record> |
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| title | 35 Uk multi-centre registry of transvenous lead extraction: clinical outcome using different techniques |
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