|Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques|
|Chu Xian-ming1,2; Li Xue-bin1; Zhang Ping1; Wang Long1; Li Ding1; Li Bing3; An Yi2; Leng Min2; Duan Jiang-bo1; Guo Ji-hong1|
|关键词||lead extraction cardiac resynchronization therapy coronary vessels infection|
|刊名||CHINESE MEDICAL JOURNAL|
|WOS标题词||Science & Technology|
|类目[WOS]||Medicine, General & Internal|
|研究领域[WOS]||General & Internal Medicine|
|关键词[WOS]||CARDIAC RESYNCHRONIZATION THERAPY ; ELECTRONIC DEVICE INFECTIONS ; EXPERIENCE ; PACEMAKER ; DEFIBRILLATOR ; MANAGEMENT ; MORTALITY|
Background Cardiac resynchronization therapy (CRT) device and coronary sinus (CS) lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques.
Methods Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 (12.0%) involved CS leads (24 CS leads). We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction.
Results Complete procedural success was achieved in 23 patients (95.8%), and the clinical success in 24 patients (100.0%). The leading indication for CS lead extraction was infection (66.7%). Mean implant duration was (29.5 +/- 20.2) months (range, 3-78 months). Sixteen CS leads (66.6%) were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads (16.7%), which had longer implant duration than other leads ((62.5 +/- 12.3) vs. (22.9 +/- 14.1) months, P<0.05). Another 4 CS (16.7%) leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes (range, 3-61 minutes) per CS lead, which had significant correlation with implant duration (r = 0.8, P<0.001). Sixteen patients (66.6%) were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months (range, 8-61 months), three patients died due to sudden cardiac death (26 months), heart failure (45 and 57 months, respectively).
Conclusion The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths. Chin Med J 2012;125(20):3707-3711
|项目编号||81001346 ; 81071246 ; 2011HZ023 ; Z121107001012016|
|资助机构||National Natural Science Foundation of China ; Medical Health Science and Technology Development Plan Project of Shandong Province, China ; Capital Clinical Project|
|作者单位||1.Peking Univ, Dept Cardiac Electrophysiol, Peoples Hosp, Beijing 100044, Peoples R China|
2.Qingdao Univ, Dept Cardiol, Affiliated Hosp, Coll Med, Qingdao 266100, Shandong, Peoples R China
3.Qingdao Univ, Dept Biol, Coll Med, Qingdao 266021, Shandong, Peoples R China
|Chu Xian-ming,Li Xue-bin,Zhang Ping,et al. Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques[J]. CHINESE MEDICAL JOURNAL,2012,125(20):3707-3711.|
|APA||Chu Xian-ming.,Li Xue-bin.,Zhang Ping.,Wang Long.,Li Ding.,...&Guo Ji-hong.(2012).Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques.CHINESE MEDICAL JOURNAL,125(20),3707-3711.|
|MLA||Chu Xian-ming,et al."Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques".CHINESE MEDICAL JOURNAL 125.20(2012):3707-3711.|