Technical Features and Clinical Outcomes of Coronary Venous Left Ventricular Lead Removal and Reimplantation

Circ J. 2021 Jul 21;85(8):1349-1355. doi: 10.1253/circj.CJ-20-1199. Epub 2021 Apr 2.

Abstract

Background: The number of patients undergoing cardiac resynchronization therapy has increased. Consequently, there is increased frequency in the removal and reimplantation of coronary venous (CV) leads due to infection or malfunction.Methods and Results:A total of 345 consecutive patients referred for lead(s) extraction were reviewed. Of these, 34 patients who underwent a CV lead removal were investigated. The indications for CV leads removal were device-related infections in 29 patients and lead malfunctions in 5 patients. The average duration of the CV leads was 4.1±3.8 years. All CV leads were successfully removed without any major complications, except for 1 in-hospital death. Successful CV lead removal by simple traction (ST) was achieved in 21 patients (62%), whereas extraction tools were required in 13 patients (38%). Local infection and CV lead dwell time were significantly associated with successful ST (P=0.04 and P=0.014, respectively). CV lead re-implantation was successfully performed in 25 patients; however, a right-side approach was required in 92%, and occlusion/stenosis of the previous CV was observed in 80% of the patients.

Conclusions: CV lead removal is relatively successful and safe. The presence of local infection and a shorter lead duration may enable successful ST of a CV lead. However, the re-implantation procedure should be well prepared for the complexity related to the right-side approach and occlusion/stenosis of the previous CV.

Keywords: Cardiac resynchronization therapy; Coronary venous lead; Laser sheath; Lead extraction; Reimplantation.

MeSH terms

  • Constriction, Pathologic
  • Defibrillators, Implantable*
  • Device Removal
  • Electrodes, Implanted
  • Hospital Mortality
  • Humans
  • Pacemaker, Artificial*
  • Replantation
  • Treatment Outcome