THE DOTTER RETRIEVER AND PIGTAIL CATHETER - EFFICACY IN EXTRACTION OFCHRONIC TRANSVENOUS PACEMAKER LEADS

Several techniques exist for percutaneous extraction of chronic pacema ker leads. To establish the efficacy of the Dotter retriever and pigta il catheter, we reviewed the removal of 59 endocardial pacemaker leads in 42 patients (mean age 71 years). The mean duration of lead implant ation was 44 months (range 1-169 months). Thirty-two leads were withdr awn with simple traction alone, and five leads were abandoned when tra ction failed. The remaining 22 leads were manipulated with a Dotter re triever or pigtail catheter, or both. Twelve leads were dislodged from the endocardium with simple traction (10) or with traction transmitte d through an entwining pigtail catheter (2), but they could not be ful ly withdrawn. Eleven of these leads (92%) were then successfully extra cted with the Dotter retriever. Seven of the remaining 10 leads were s uccessfully dislodged and removed by the Dotter retriever. Overall, 9 of 12 leads (75%) that could not be dislodged from the endocardium wit h simple traction were removed with a Dotter retriever or pigtail cath eter, or both. Three patients in whom no catheter method worked requir ed thoracotomy for removal of infected leads. No complications resulte d from use of the Dotter retriever or pigtail catheter. We conclude th at the Dotter retriever and pigtail catheter have moderate efficacy fo r dislodging chronic endocardial leads. Once mobilized, however, the l eads can be withdrawn with great success with the Dotter retriever. Ne wer technology should not result in the abandonment of this proven tec hnique.