Feasibility, safety, and determinants of extraction time of percutaneous extraction of endocardial implantable cardioverter defibrillator leads by intravascular countertracion method

Previous studies of the removal of implantable cardioverter defibrillator ( ICD) leads have been restricted to case reports or small series. In this re port, we describe our experience in ICD lead extraction by intravascular co untertraction method using Cook's extraction kit. A total of 47 high-voltag e (HV) leads, 3 rate sensing (S) reads, and 2 subcutaneous arrays were remo ved from 42 patients (33 men, 9 women; mean age 59 years [range 14 to 81]). One HV superior vena cava (SVC) lead and 11 HV right ventricular (RV) lead s were explanted by manual traction only and defined in the "lead removal" category. One S lead was removed using a femoral venous approach. The remai ning 37 leads were explanted by SVC approach using extraction sheaths and d efined in the "lead extraction" category. Twenty leads were extracted for " infectious" (group A) and 17 leads for "noninfectious" (group B) etiologies for which extraction times of 27.0 +/- 18.0 and 27.0 +/- 15.0 minutes (mea n +/- SD), respectively, were not different. Although extraction time, 34.0 +/- 11.0 minutes, for leads implanted for >48 months was longer than 23.0 +/- 16.0, 28.0 +/- 18.0, and 24.0 +/- 14.0 minutes, for leads with implant durations of 12, 24, and 48 months, respectively, such differences were not statistically significant. The extraction time, however, was directly rela ted to the degree of fibrosis around the lead, 39.0 +/- 15.0 minutes for le ads with severe fibrosis compared with 13.0 +/- 6.0 minutes for the leads w ith mild fibrosis (p <0.001). Patient's age, sex, or history of coronary ar tery bypass graft surgery did not significantly affect extraction time. All except the initial 2 lead extractions were performed in the electrophysiol ogy laboratory. No mortality or serious complications associated with the p rocedure using these methods were observed. (C)2000 by Excerpta Medico, Inc .