Assessment of the Impact of Organisational Model of Transvenous Lead Extraction on the Effectiveness and Safety of Procedure: an Observational Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2022 Dec 29

PMID 36581437

Authors

Lukasz Tulecki

Wojciech Jachec

Anna Polewczyk

Marek Czajkowski

Sylwia Targonska

Konrad Tomkow

Kamil Karpeta

Dorota Nowosielecka

Andrzej Kutarski

Affiliations

Soon will be listed here.

Abstract

Objectives: To estimate the impact of the organisational model of transvenous lead extraction (TLE) on effectiveness and safety of procedures.

Design: Post hoc analysis of patient data entered prospectively into a computer database.

Setting: Data of all patients undergoing TLE in three centres in Poland between 2006 and 2021 were analysed.

Participants: 3462 patients including: 985 patients undergoing TLE in a hybrid room (HR), with cardiac surgeon (CS) as co-operator, under general anaesthesia (GA), with arterial line (AL) and with transoesophageal echocardiography (TEE) monitoring (group 1), 68 patients-TLE in HR with CS, under GA, without TEE (group 2), 406 patients-TLE in operating theatre (OT) using 'arm-C' X-ray machine with CS under GA and with TEE (group 3), 154 patients-TLE in OT with CS under GA, without TEE (group 4), 113 patients-TLE in OT with anaesthesia team, using the 'arm-C' X-ray machine, without CS (group 5), 122 patients-TLE in electrophysiology lab (EPL), with CS under intravenous analgesia without TEE and AL (group 6), 1614 patients-TLE in EPL, without CS, under intravenous analgesia without TEE and AL (group 7).

Key Outcome Measure: Effectiveness and safety of TLE depending on organisational model.

Results: The rate of major complications (MC) was higher in OT/HR than in EPL (2.66% vs 1.38%), but all MCs were treated successfully and there was no MC-related death. The use of TEE during TLE increased probability of complete procedural succemss achieving about 1.5 times (OR=1.482; p<0.034) and were connected with reduction of minor complications occurrence (OR=0.751; p=0.046).

Conclusions: The most important condition to avoid death due to MC is close co-operation with cardiac surgery team, which permits for urgent rescue cardiac surgery. Continuous TEE monitoring plays predominant role in immediate decision on rescue sternotomy and improves the effectiveness of procedure.

Citing Articles

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature-Description of Different Approaches and Tools.

Kutarski A, Jachec W, Pietura R, Czajkowski M, Stefanczyk P, Kosior J J Clin Med. 2025; 14(1.

PMID: 39797364 PMC: 11720824. DOI: 10.3390/jcm14010282.

Leads with the Cut Proximal Ends Migrated into the Heart and Vasculature: A Rare Phenomenon among 3847 Lead Extraction Procedures.

Kutarski A, Jachec W, Pietura R, Stefanczyk P, Kosior J, Czajkowski M J Clin Med. 2024; 13(9).

PMID: 38731132 PMC: 11084147. DOI: 10.3390/jcm13092602.

Lead Break during Extraction: Predisposing Factors and Impact on Procedure Complexity and Outcome: Analysis of 3825 Procedures.

Kutarski A, Jachec W, Czajkowski M, Stefanczyk P, Kosior J, Tulecki L J Clin Med. 2024; 13(8).

PMID: 38673622 PMC: 11051408. DOI: 10.3390/jcm13082349.

References

Maus T, Shurter J, Nguyen L, Birgersdotter-Green U, Pretorius V . Multidisciplinary approach to transvenous lead extraction: a single center's experience. J Cardiothorac Vasc Anesth. 2015; 29(2):265-70. DOI: 10.1053/j.jvca.2014.11.010. View

Sood N, Martin D, Lampert R, Curtis J, Parzynski C, Clancy J . Incidence and Predictors of Perioperative Complications With Transvenous Lead Extractions: Real-World Experience With National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol. 2018; 11(2):e004768. DOI: 10.1161/CIRCEP.116.004768. View

Jachec W, Polewczyk A, Polewczyk M, Tomasik A, Kutarski A . Transvenous Lead Extraction SAFeTY Score for Risk Stratification and Proper Patient Selection for Removal Procedures Using Mechanical Tools. J Clin Med. 2020; 9(2). PMC: 7073714. DOI: 10.3390/jcm9020361. View

Kusumoto F, Schoenfeld M, Wilkoff B, Berul C, Birgersdotter-Green U, Carrillo R . 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017; 14(12):e503-e551. DOI: 10.1016/j.hrthm.2017.09.001. View

Love C, Wilkoff B, BYRD C, Belott P, Brinker J, Fearnot N . Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol. 2000; 23(4 Pt 1):544-51. DOI: 10.1111/j.1540-8159.2000.tb00845.x. View

Deharo J, Bongiorni M, Rozkovec A, Bracke F, Defaye P, Fernandez-Lozano I . Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper. Europace. 2011; 14(1):124-34. DOI: 10.1093/europace/eur338. View

Diaz C, Guo X, Whitman I, Marcus G, Pellegrini C, Beygui R . Reported mortality with rotating sheaths vs. laser sheaths for transvenous lead extraction. Europace. 2019; 21(11):1703-1709. DOI: 10.1093/europace/euz238. View

Issa Z . Transvenous lead extraction in 1000 patients guided by intraprocedural risk stratification without surgical backup. Heart Rhythm. 2021; 18(8):1272-1278. DOI: 10.1016/j.hrthm.2021.03.031. View

Bongiorni M, Burri H, Deharo J, Starck C, Kennergren C, Saghy L . 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace. 2018; 20(7):1217. DOI: 10.1093/europace/euy050. View

10.

Jachec W, Polewczyk A, Polewczyk M, Tomasik A, Janion M, Kutarski A . Risk Factors Predicting Complications of Transvenous Lead Extraction. Biomed Res Int. 2019; 2018:8796704. PMC: 6312591. DOI: 10.1155/2018/8796704. View

11.

El-Chami M, Merchant F, Levy M, Alam M, Rattan R, Hoskins M . Outcomes of Sprint Fidelis and Riata lead extraction: Data from 2 high-volume centers. Heart Rhythm. 2015; 12(6):1216-20. DOI: 10.1016/j.hrthm.2015.02.031. View

12.

BYRD C, Wilkoff B, Love C, Sellers T, Turk K, Reeves R . Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol. 1999; 22(9):1348-57. DOI: 10.1111/j.1540-8159.1999.tb00628.x. View

13.

Bashir J, Fedoruk L, Ofiesh J, Karim S, Tyers G . Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction. Circ Arrhythm Electrophysiol. 2016; 9(9). DOI: 10.1161/CIRCEP.115.003741. View

14.

Jachec W, Polewczyk A, Segreti L, Bongiorni M, Kutarski A . To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment. Pacing Clin Electrophysiol. 2019; 42(7):1006-1017. DOI: 10.1111/pace.13715. View

15.

Bongiorni M, Blomstrom-Lundqvist C, Kennergren C, Dagres N, Pison L, Svendsen J . Current practice in transvenous lead extraction: a European Heart Rhythm Association EP Network Survey. Europace. 2012; 14(6):783-6. DOI: 10.1093/europace/eus166. View

16.

Segreti L, Giannotti Santoro M, Cori A, Fiorentini F, Zucchelli G, Bernini G . Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads. Europace. 2020; 22(9):1401-1408. DOI: 10.1093/europace/euaa134. View

17.

Maytin M, Jones S, Epstein L . Long-term mortality after transvenous lead extraction. Circ Arrhythm Electrophysiol. 2012; 5(2):252-7. DOI: 10.1161/CIRCEP.111.965277. View

18.

Kennergren C, Bjurman C, Wiklund R, Gabel J . A single-centre experience of over one thousand lead extractions. Europace. 2009; 11(5):612-7. PMC: 2675028. DOI: 10.1093/europace/eup054. View

19.

Brunner M, Cronin E, Wazni O, Baranowski B, Saliba W, Sabik J . Outcomes of patients requiring emergent surgical or endovascular intervention for catastrophic complications during transvenous lead extraction. Heart Rhythm. 2013; 11(3):419-25. DOI: 10.1016/j.hrthm.2013.12.004. View

20.

Wilkoff B, Love C, Byrd C, Bongiorni M, Carrillo R, Crossley 3rd G . Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm. 2009; 6(7):1085-104. DOI: 10.1016/j.hrthm.2009.05.020. View