Ancillary tools in pacemaker and defibrillator lead extraction using a novel lead removal system

A previous report described our preliminary experience with a highly succes sful pacing lead removal system (VascoExtor). Extending this experience, we found it necessary to use additional tools to enhance the success of percu taneous lead extraction with this system. In the present series, we used th e standard locking stylers (S and K), and recently, one newer type of style r (Magic) over the last 3 years in 34 patients to extract 48 pacemaker lead s in 31 patients and 3 defibrillator (ICD) leads in 3 patients. Lead extrac tion was carried out in 23 men and 11 women (aged 64 +/- 17 years) because of pacemaker infection (n = 21), pacemaker (n = 8) or ICD (n = 3) lead malf unction, or prior to ICD implant (n = 2). Leads were in place for 3.5 +/- 3 .7 years. Infections, involving pocket and lead(s), were due to S. epidermi dis (n = 13), S. aureus In = 6), S. aureus plus E, coli (n = I), or fungi ( n = Il. Of the 48 pacing leads, 31 were ventricular, 15 atrial, and 2 were VDD leads. The ICD leads were two double-coil leads (CPI) and one single-co il lead (Telectronics). Using She S (n = 12), K (II = 8), or Magic (n = 3) stylers, all pacing leads in 23 patients and the ICD leads in 2 patients we re successfully removed from a subclavian approach using the locking styler s. However, in nine (26.5%) patients ancillary tools were required. In four patients, lead fragments were captured with use of a noose catheter, a pig tail catheter, and a bioptome from a right femoral approach. In two patient s, locking could not be effected and a noose catheter from the right femora l vein was used, aided by a pigtail and an Amplatz catheter and 17 bioptome to remove three leads. In a patient with an ICD lead, a combined subclavia n (stylet S) and right femoral approach (noose catheter) was required. in a patient with a dysfunctional ventricular lead 12 years old, a motor drive unit was used to facilitate the exchange of locking stylers, but extraction failed. In another patient, a fragment of a dysfunctional ventricular lead remained intravascularly despite resorting to a femoral approach. Finally, lead removal was completely (32/34, 94%) or partially (1/34, 3%) successfu l in 33 (97%) of 34 patients for 50 (98%) of 51 leads without complications . In conclusion, to enhance the success of pacing or ICD lead extraction wi th use of the VascoExtor locking stylers, an array of ancillary tools were required in more than one fourth of patients.