所属 医学部 医学科（東京女子医科大学病院） 職種 特任准教授
|発表タイトル||Transvenous Lead Extraction of Non-infectious Abandoned Leads during Lead Revisions and Upgrades of Cardiac Implantable Electronic Devices|
|発表者・共同発表者||◎樋口諭, 庄田守男, 齋藤聡, 金井美和, 矢崎恭一郎, 柳下大悟, 江島浩一郎, 萩原誠久|
|概要||*Oral Presentation (Japanese)25 Pacemaler & Lead Extraction
Introduction: During implantations of additional new leads for lead failure or upgrading cardiac implantable electronic devices (CIEDs), most abandoned leads are left in patients. However, recent clinical investigations have indicated that abandoned leads may cause complications such as infections, arrhythmias, vascular trouble and thromboembolisms. This study aimed to report the clinical outcome of transvenous non-infectious abandoned lead extractions (TLEs) at highvolume Japanese centers.Methods and Results: We analyzed 51 patients (34 with lead revisions and 17 with CIED upgrades) who underwent TLEs for non-infectious abandoned leads from 2008 to 2018 at our institution. The indications for TLEs were based on the "HRS Expert consensus in 2009 ": occluded venous access (19 patients), more than 4 leads on 1 side (12), threatening risk if left in place (2), need for MRI conditional CIEDs (2), short implantation times (7), younger age (6), and growth of the body size (3). In total, 22 functional leads and 42 non-functional leads were extracted with a mean implantation time of 7.0 years. Twelve leads (31%) were extracted manually, and 44 (69%) required mechanical sheaths and/or excimer laser sheaths. Snares were used for 24 leads (38%). All coexisting leads, which should be continuously used, were not damaged during the procedures. Complete removal could be achieved in 97% of the leads and clinical success in all patients. There were no TLE procedural complications. Conclusions: TLEs of non-infectious abandoned leads can be a therapeutic option during lead revisions and CIED upgrades rather than traditional capping of the leads left in the pocket, which may later cause complications.