EJIMA KOICHIRO
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Associate Professor (Fixed Term)
Language English
Title Clinical and Procedural Features of Left Ventricular Lead Extraction in Patients with Cardiac Resynchronization Therapy
Conference The 66th Annual Meeting of The Japanese Heart Rhythm Society
Promoters Japanese Heart Rhythm Society
Conference Type Nationwide Conferences
Presentation Type Speech
Lecture Type Panelist at Symposium/Workshop (Appointed)
Publisher and common publisher◎YAGISHITA Daigo, SHODA Morio, SAITO Satoshi, HIGUCHI Satoshi, KANAI Miwa, YAZAKI Kyoichiro, EJIMA Koichiro, HAGIWARA Nobuhisa
Date 2019/07/27
Venue
(city and name of the country)
Yokohama, JAPAN
Summary *Symposium 14
Unresolved Issues of Cardiac Device and Lead Extraction

[Object] Lead extraction (LE) has been a standard procedure of lead management, however, the outcome of LE in patients with cardiac resynchronization therapy (CRT) has not been well evaluated. Then we aimed to investigate clinical and procedural features of left ventricular (LV) lead extraction (LV-LE).

[Methods] Twenty-seven consecutive patients (64.0 ± 10.2 years, Male 78%) referred to our hospital for LV-LE (except Attain StarFix, Medtronic) from August 2008 to January 2019 were enrolled.

[Results] The LV-LE indication was infection in 25 patients (81.5%) and lead malfunction in 5 patients (18.5%). Mean duration of LV lead implantation was 4.7 ± 3.9years. The method of LV-LE was simple manual traction in 18 patients (ST
group, 66.7%) and complex procedure with mechanical/powered sheath and/or femoral approach using snaring techniques in 9 patients (CP group, 33.3%). The infection indication was significantly more in ST than CP (94.4% vs. 55.6%, P=0.03), and the implantation duration was shorter in ST (3.7years vs. 6.7years, P=0.04). Additional LE of atrial or ventricular lead was required in 23 patients, and complex procedure was not required in 6 (18.5%). In those patients, the implantation duration of the oldest lead was significantly shorter (2.3years vs. 5.1years, P=0.03), while the LE indication was similar. The complete procedure success rate was 96.3%, with the remaining 3.7% partial success.

[Conclusions] LV lead extraction with relatively short implantation duration is feasible with a high success rate, and the procedural difficulty could be associated with non-infectious indication and longer implantation duration. Further investigations are needed for much older LV-LE.