Vascular Health and Risk Management (Aug 2021)

Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

  • Stefańczyk P,
  • Nowosielecka D,
  • Tułecki,
  • Tomków K,
  • Polewczyk A,
  • Jacheć W,
  • Kleinrok A,
  • Borzęcki W,
  • Kutarski A

Journal volume & issue
Vol. Volume 17
pp. 445 – 459

Abstract

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Paweł Stefańczyk,1 Dorota Nowosielecka,1 Łukasz Tułecki,2 Konrad Tomków,2 Anna Polewczyk,3,4 Wojciech Jacheć,5 Andrzej Kleinrok,1,6 Wojciech Borzęcki,1 Andrzej Kutarski7 1Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland; 2Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland; 3Department of Physiology, Pathophysiology, and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland; 4Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland; 5Silesian Medical University, 2nd Department of Cardiology, Zabrze, Poland; 6Medical College, Department of Physiotherapy, University of Information Technology and Management, Rzeszów, Poland; 7Department of Cardiology, Medical University, Lublin, PolandCorrespondence: Anna PolewczykDepartment of Physiology, Pathophysiology, and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 19A, Aleja IX Wieków Kielc Str 25-317, Kielce, PolandTel +48600024074Email [email protected]: Transvenous lead extraction (TLE) is now a first-line technique for the treatment of complications related to cardiac implantable electronic devices. The aim of the study was to demonstrate that it is possible to safely perform difficult TLE procedures with a maximum reduction of peri-procedural major complications.Methods: A total of 1000 consecutive patients undergoing TLE in a single high-volume center from 2016 to 2019 were studied. All procedures were performed in a hybrid room or operating room by a specialized TLE team. TLE was performed under general anesthesia and monitored by transesophageal echocardiography, and the operating room was suitably equipped for immediate surgical intervention. The effectiveness and safety of the procedures were assessed, with particular emphasis on major complications.Results: In all, 1952 leads with the mean implant duration of 111.7 ± 77.6 months had been extracted. Complete procedural success of patients was achieved in 95.9% and clinical success in 99.1%. Major complications, predominantly cardiac tamponade (63.3%), occurred in 22 patients (2.2%). Rapid diagnosis and immediate intervention were the key to a 100% survival in patients with this complication.Conclusion: Performing procedures in a hybrid operating room under general anesthesia in the presence of a cardiac surgeon and with the use of transesophageal echocardiography significantly improves the safety of transvenous lead extraction.Keywords: lead extraction, complications of lead extraction, venue of TLE, mechanical dilatation, safety precautions

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