Transvenous Lead Extraction in the Left Ventricular Assist Device Patient.

The population of patients with advanced heart failure continues to increase steadily as does the need for mechanical circulatory support. Combination therapy with left ventricular assist devices (LVADs) and cardiovascular implantable electronic devices (CIEDs) is unavoidable. CIED complications in patients with LVADs are common and often necessitate device system revision and transvenous lead extraction.

Percutaneous management of superior vena cava syndrome in patients with cardiovascular implantable electronic devices.

Background: There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome.

Objective: We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome.

Methods: We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome.

Transvenous lead extraction during uninterrupted warfarin therapy: Feasibility and outcomes.

Background: Uninterrupted anticoagulation is important for patients at high risk for thromboembolism. Bridging with heparin/enoxaparin increases the risk of hematoma and infection. There are no published data on the feasibility of transvenous lead extraction (TLE) during uninterrupted anticoagulation.

Strategies for Transvenous Lead Extraction Procedures.

Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis.

Epicardial phrenic nerve displacement during catheter ablation of atrial and ventricular arrhythmias: procedural experience and outcomes.

Background: Arrhythmia origin in close proximity to the phrenic nerve (PN) can hinder successful catheter ablation. We describe our approach with epicardial PN displacement in such instances.

Methods And Results: PN displacement via percutaneous pericardial access was attempted in 13 patients (age 49±16 years, 9 females) with either atrial tachycardia (6 patients) or atrial fibrillation triggered from a superior vena cava focus (1 patient) adjacent to the right PN or epicardial ventricular tachycardia origin adjacent to the left PN (6 patients).

ICD and CRT use in ischemic heart disease in women.

Although the role of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in improving outcomes in ischemic cardiomyopathy (ICM) has been described, the data regarding gender-based survival outcomes are limited. There is a higher preponderance of non-ischemic cardiomyopathy (NICM) in women, and most of the ICM literature is derived from sub-study analysis. This review summarizes the current body of literature on prognosis, pathophysiology, and the present clinical practice for device implantation in women with ICM.

Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment?

Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure.

Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation.

Background: Cardiac sarcoid-related ventricular tachycardia (VT) is a rare disorder; the underlying substrate and response to ablation are poorly understood. We sought to examine the ventricular substrate and outcomes of catheter ablation in this population.

Methods And Results: Of 435 patients with nonischemic cardiomyopathy referred for VT ablation, 21 patients (5%) had cardiac sarcoidosis.

Virtual reality lead extraction as a method for training new physicians: a pilot study.

Background: It is estimated that the demand for transvenous lead extraction (TLE) has reached an annual extraction rate of nearly 24,000 patients worldwide. Despite technologic advances, TLE still has the potential for significant morbidity and mortality. Complication rates with TLE directly parallel operator experience.

Multicenter experience with extraction of the Riata/Riata ST ICD lead.

Background: In November 2011, the Food and Drug Administration issued a class I recall of Riata and Riata ST implantable cardioverter-defibrillator leads. Management recommendations regarding the recall have remained controversial.

Objective: Data regarding the safety and feasibility of extraction of Riata implantable cardioverter-defibrillator leads are limited.

Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC).

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC.

Methods: We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high-volume centers.

Lead electrical parameters may not predict integrity of the Sprint Fidelis ICD lead.

Background: The reported failure rate of the Medtronic Sprint Fidelis defibrillator lead continues to increase over time. Clinicians and patients count on the electrical analysis of leads through device interrogation to determine whether a lead is functioning "normally." Most importantly, this analysis is often the basis for decision making around the ongoing use of this lead at the time of generator change.

Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads.

Background/objective: Active fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited.

Methods: We performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers.

Long-term mortality after transvenous lead extraction.

Background: The number of cardiovascular implantable electronic devices has increased progressively and has led to an increased need for transvenous lead extraction (TLE). Multiple reports of TLE procedural outcomes exist; however, data regarding postprocedural and long-term mortality are limited.

Methods And Results: We performed a retrospective study of consecutive patients undergoing TLE at a single, high-volume center.

Lead implant duration does not always predict ease of extraction: extraction sheath may be required at < 1 year.

Introduction: Lead implant duration is a predictor of extraction sheath (ES) use in transvenous lead extraction (TLE). Most operators agree that leads with short implant durations can be extracted easily but data regarding defibrillator (implantable cardioverter-defibrillator [ICD]) leads and newer generation leads with backfilled coils are limited.

Methods And Results: We performed a retrospective study of consecutive patients undergoing TLE of leads with implant durations of ≤ 2 years at a single, high-volume center.