C a s e S e r i e s an d R e v i e w o f

L i t e r a t u re f o r Su p e r i o r
Ven a C a v a I n j u r y D u r i n g L a s e r
L ea d Extract ion
Efehi Igbinomwanhia, MD, MPHa,*, Sania Jiwani, MDb, Saima Karim, DOa,
Rhea Pimentel, MDb

KEYWORDS
 Multidisciplinary approach to laser lead extraction  Incidence of superior vena cava injury
 Risk factors for superior vena cava injury  Superior vena cava bridge balloon utilization

KEY POINTS
 Superior vena cava injury during transvenous lead extraction is rare, but causes significant
morbidity and mortality.
 Patient-related, device-related, and procedure-related risk factors may contribute to complications
due to transvenous lead extractions, including superior vena cava injury.
 Perioperative preparation with a multidisciplinary team approach is essential in the timely manage-
ment of superior vena cava injury during transvenous lead extraction.

INTRODUCTION surgical management of vascular complications

can decrease mortality. The authors review two
Transvenous laser lead extraction has a major cases involving SVC tears and various methods
complication rate reported in the range of 0.19% deployed in preparation for lead extraction.
to 1.8% and minor complication rate reported in
the range of 0.6% to 6.2%1 (Tables 1 and 2).
CASES
Lead extraction requires preparation and coordina-
Case 1
tion between multiple teams to avoid poor out-
comes and expeditiously treat complications. The A 57-year-old woman with a history of tobacco
most feared complication is a superior vena cava abuse, and syncope due to complete heart block
(SVC) or SVC-right atria junction (SVC-RA) injury. with dual-chamber Medtronic pacemaker was
The rate of vascular laceration during lead extrac- seen in clinic for persistently elevated right ventric-
tion ranges from 0.19% to 0.96%.1 Procedural ular (RV) threshold and battery status indicating
planning includes assessment of high-risk patient elective replacement indicator (ERI). Patient had
and device characteristics with preoperative imag- Medtronic right atrial (RA) lead (model 5068, length
ing and blood work. Cardiothoracic surgery (CTS) 52 cm) and the RV lead (model 5068, length 58 cm)
consultation can be instrumental in the workup of implanted 21 years ago with latest generator being
the patient. During the procedure, certain mea- 8 year old (Medtronic, model ADDRL1). After dis-
sures can be employed preemptively to manage cussion of risks, benefits, and options, she opted
complications in the event of an SVC or SVC-RA to move forward with a transvenous lead extrac-
injury. CTS backup availability and expedient tion (TLE) and generator change. Her transthoracic
cardiacEP.theclinics.com

a
Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, 2500 Metro-
health Drive, Cleveland, OH 44109, USA; b Department of Cardiovascular Medicine, University of Kansas Med-
ical Center, 3901 Rainbow Boulevard, Mailstop 4023, Kansas City, KS 66160, USA
* Corresponding author. Heart and Vascular Institute, MetroHealth Medical Center, 2500 Metrohealth Drive,
Cleveland, OH 44109.
E-mail address: eigbinomwanhia@metrohealth.org

Card Electrophysiol Clin 16 (2024) 117–124

https://doi.org/10.1016/j.ccep.2023.10.011
1877-9182/24/Published by Elsevier Inc.
Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
118 Igbinomwanhia et al

Table 1
Risk factors for transvenous lead extraction dependent on patient characteristics, device characteristic,
and procedure-specific risk factors

Patient-related factors
Female sex  Higher risk of major complications2,6–9
BMI <25 kg/m2  Higher risk of major adverse events as well as in-hospital3 and
30-d all-cause mortality10
Diabetes mellitus  Higher in-hospital all-cause mortality3
Renal dysfunction  Creatinine 2.0 mg/dL: Higher in-hospital all-cause mortality3
 End stage renal disease: Higher mortality at 1 month and
6 month11
Left ventricular dysfunction  Higher rate of major complications10
(ejection fraction <15%)
Anemia  Hemoglobin <11.5 g/dL: Higher odds of major complications
 Higher 30-d all-cause mortality7,12
Procedural and device factors
Number of leads extracted  Higher risk of major complications with 3 leads
extracted6,13,14
Implant duration  8%–22% higher odds of major complications per 1 year of
implant duration6,15
 Mean lead dwell time of >10 year: Independent predictor for
vascular avulsion/tear15
Infection as indication for  Higher rate of complications and 30-d all-cause mortality6
extraction
Occlusion or critical stenosis  Independent predictor for vascular avulsion or tear16
of the superior venous access
Targeted leads on both right  Increased risk of complications with laser extraction9,17
and left sides
Dual-coil ICD leads  More difficult to remove than single-coil ICD leads18
 Higher 30-d all-cause mortality10
Lead diameter, coil shape,  Higher rate of complications with extraction of ICD leads6
proximal coil surface area
ePTFE-coated ICD leads  Shorter procedure times and less need for advanced tools19,20

echocardiogram (TTE) showed normal left ventric- line provided to anesthesia in the event of blood
ular (LV) and RV size and function. Non-contrast transfusion. Further, an arterial line was placed.
computerized tomography (CT) obtained showed Subsequently, patient underwent laser lead
leads adherent to SVC/RA area, RV lead being at extraction using a #2 lead locking stylet and a
apex, moderate coronary calcification, thoracic 14-French 80 Hz energy Spectranetics laser that
aortic calcification, and centrilobular emphysema. was unsuccessful due to significant vascular calci-
CTS and preoperative anesthesia teams were fication. Therefore, a mechanical extraction tool
consulted. All anticoagulants were held 5 days was used. Although TLE was performed around
before the planned TLE. the SVC-RA junction, the patient was noted to be
After the patient underwent sterile draping and hypotensive and had transient pulseless electrical
prepping in the hybrid operating room (OR), bilat- arrest for 2 minutes requiring chest compression.
eral femoral venous access was obtained. A Patient was immediately stabilized after resuscita-
Bridge balloon was deployed for appropriate posi- tion. Transesophageal echocardiogram (TEE)
tion and then retracted into the inferior vena cava showed a moderate loculated effusion by the RV.
after marking optimal deployment position over Blood transfusion was initiated, and laboratory
the Amplatz wire through a 12-Fr sheath. Other workup was urgently sent. CTS was called as the
femoral access consisted of a 7-French sheath, Bridge balloon was deployed. Via the subclavian
through which a temporary backup pacing cath- vascular access now available, new RV lead (Med-
eter was placed as patient was atrial-dependent. tronic 5076, length 58 cm) was placed while await-
The femoral sheaths were also connected to a ing surgical backup.

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
 Case Series and Review of Literature 119

Table 2
Periprocedural management and preparation for transvenous lead extraction

Periprocedural Management Description

Risk assessment Review patient’s medical history and lead characteristics
Use risk stratification tools
Multidisciplinary team Involvement of electrophysiologists, cardiac surgeons,
anesthesiologists, and support staff preoperatively
A cardiac surgeon with the ability to provide emergent
thoracotomy in <5 minute should be available42
Imaging modality Chest x-ray, cardiac computed tomography, venography for
additional risk assessment can be used21–27
Transesophageal echocardiography (TEE) or intracardiac
echocardiography (ICE) for continuous procedural
monitoring34,35
Anticoagulation management Individualize anticoagulation use, taking in account
thromboembolic risk31
Anesthesia and sedation General anesthesia with controlled ventilation for most cases
given TEE utility in most cases
Vascular access Plan for large-bore vascular sheaths and femoral access
Plan for arterial line for continuous hemodynamic
measurement
Endovascular balloon Balloons for SVC occlusion can be considered43
May be reasonable to preposition in high-risk cases44

CTS arrived within 3 minutes and emergent with generator change. Device interrogation
midline incision sternotomy was performed. Peri- demonstrated 81% RA pacing and 2.5% RV pac-
cardium was opened and good hemostasis was ing with intermittent oversensing of RA lead with
obtained. Proximal control was obtained at the stable impedance and elevated RV lead thresh-
SVC-RA junction along with distal SVC control, olds. A decision was made to extract and reim-
while the bridge balloon was still deployed. Clips plant both leads after risks and potential
were deployed over a small branch of the azygous, complications were discussed with the patient in
whereas repair sutures were placed on the poste- detail.
rior aspect of the SVC and the RA junction. There Device consisted of Abbott Medical isodia-
was now reasonable resuscitation of the patient metric 7-French RV (model 1948, length 52 cm,
and good control of bleeding. Two temporary ven- passive fixation) and RA (model 1944, length
tricular wires were placed and secured as the pa- 46 cm, passive fixation) leads. The outer insulation
tient was dependent on pacing. The permanent was composed of polyurethane and silicone. Pre-
pacer was set to dual chamber pacing mode operative TTE showed normal LV function and
with a rate of 60 to 120 beats per minute, and chest x-ray suggested axillary vein access. CT
the backup epicardial pacer was set to 40 beats scan revealed both leads hugged the lateral wall
per minute ventricular pacing. The Sternum was of SVC/RA junction with RV lead terminating in api-
packed, and patient was transported back to the cal septum and RA lead in the RA appendage. The
ICU in critical, but hemodynamically stable patient underwent CTS and anesthesia consult
condition. before procedure. Appropriate blood work was
also obtained.
The procedure was performed under general
Case 2
anesthesia in a hybrid OR. Intraoperative baseline
A 66-year-old woman (body mass index [BMI] TEE before the procedure showed normal LV func-
24.5 kg/m2) with a history of supraventricular tion and trace pericardial effusion. The patient was
tachycardia, hypertension, hyperlipidemia, seizure prepped and draped, and right femoral arterial and
disorder, tobacco abuse, and sinus node dysfunc- bilateral femoral venous accesses were obtained.
tion with placement of Abbott dual-chamber pace- An Amplatzer exchange length wire was advanced
maker 8 years prior presented to the office with through the 12-Fr right femoral vein for potential
atrial lead malfunction and generator at ERI. She Bridge balloon deployment. A temporary transve-
was referred for RA removal and reimplantation nous pacer was also placed. The generator and

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
120 Igbinomwanhia et al

the leads were dissected out in pocket before risk of extraction is SVC injury often leading to
disconnection. rapid hemodynamic compromise and death. A
Gentle traction on the leads indicated vascular ad- study of 91,890 TLR procedures identified using
hesions. A #2 locking stylet was placed to the tip of the Nationwide Inpatient Sample from 2006 to
the RV lead. Using 80-Hz energy, a Spectranetics 2012 showed a 2.0% overall rate of vascular injury
14-Fr laser sheath was advanced from the access with a significant increase in trend over the study
site to the midportion of the SVC. 40-Hz pulsation period.2 The LExICon study had a 0.41% rate of
was then applied around the SVC/RA junction with vascular tear (including axillary artery tear)
gentle traction which released the RV lead from requiring thoracotomy, pericardiocentesis, chest
myocardium without any complications, changes tube, or surgical repair.3 Most SVC tears during
in blood pressure, or pericardial effusion. TLE occur in the isolated body of the SVC.4 The
Next, a #2 locking stylet was inserted in RA lead recently published retrospective multicenter
but could not be advanced beyond the SVC/RA CLEAR study reported risk factors associated
junction due to suspected lead fracture. With a with perforation which include no history of car-
14-Fr laser, 40-Hz pulsations were used to diac surgery, female sex, preserved LV ejection
advance the laser sheath through the SVC/RA fraction, lead age greater than 8 years, 2 leads
junction. The patient remained hemodynamically extracted, and diabetes.5
stable without new pericardial effusion on TEE. The authors discuss the various risk factors for
Having arrived at the juncture where the locking major complications associated with lead extrac-
stylet ended, moderate manual traction on the tion, subdividing them into patient characteris-
lead with forward pressure using the laser sheath tics, device characteristics, and procedural
alone was applied. At this point, there was a rapid characteristics.
drop in the patient’s systolic blood pressure from
120 to 50 mm Hg. Cardiopulmonary resuscitation PATIENT CHARACTERISTICS
was initiated immediately. Repeat TEE imaging
revealed no new pericardial effusion. Female sex is associated with a higher risk of
CTS was in the control room and activated. procedural complications from TLE in general
Massive transfusion protocol was initiated. While (especially for high voltage leads) with 1.19 to
cardiopulmonary resuscitation was continued, 2.74 higher odds of complications in multiple
the bridge balloon was deployed. CT surgery studies.3,6–9 The patient’s BMI less than 25 kg/
team performed emergent sternotomy with a large m2 portends a higher risk of procedure-related
amount of clot noted in pericardium. The patient major adverse events, in-hospital,3 and 30-day
was placed on a cardiac bypass pump and all-cause mortality.10 Patients with diabetes melli-
required cardiac massage for ventricular fibrillation tus as well as with creatinine 2.0 mg/dL have
during the transition. An SVC laceration was iden- been shown to have a higher rate of in-hospital
tified, and primary repair performed. The RA lead mortality.3 End-stage renal disease with dialysis
was abandoned and clipped at the pocket level. dependency is associated with higher mortality
A temporary epicardial wire was placed. The at 1 month (Hazard ratio [HR] 5.60 [2.67–11.53])
vascular access was oversewn, and chest pocket and 6 months (HR 2.81 [1.74–4.42]).11 Also, an
closed. ejection fraction of 15% correlates with a signif-
Postoperatively, the patient was monitored in icantly higher risk of major complication.10 The
the ICU setting. She was gradually weaned off he- presence of anemia with hemoglobin concentra-
modynamic support and extubated. Epicardial tion less than 11.5 g/dL is associated with a
pacing lead was removed. greater than two times odds of major complica-
tions7,12 and every 1 g/dL lower hemoglobin
DISCUSSION concentration leads to an increase in major com-
plications by 22.4% to 27.4%.9 The presence of
Leads from cardiac implantable electronic devices anemia is also associated with a higher 30-day
are exposed to continual stress, leading to a finite all-cause mortality odds ratio (OR) 3.3; 95% CI:
lifespan. As patient longevity improves with exist- 2.0–5.0).10
ing devices, a concomitant increase in device
complications, including lead malfunction and PREOPERATIVE DEVICE RISK FACTORS
infection, exists. The long-term risks of simply
abandoning leads must be balanced against the Device characteristics play a key role in deter-
risk of complex TLE. TLE is often considered a mining procedural risk. The number of leads
high-risk procedure, but large observational extracted6,13 and longer lead implant duration6,14
studies have not borne this out. The most feared are widely recognized risk factors for major

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
 Case Series and Review of Literature 121

complications. The risk of complications is twofold potential contraindications that may affect the pro-
when three or more leads are extracted. The odds cedure. Preoperative imaging also plays a crucial
of complications increase by 8% to 22% per role in preoperative preparation and surgical
1 year of implant duration.6,15 Leads greater than response.
10 year old were shown to pose the highest risk All patients should undergo a chest x-ray, which
with 13 times odds of complications when provides information regarding lead positioning/
compared with leads less than 5 year old.15 A course, integrity, type of fixation, and lead design.
mean lead dwell time of greater than 10 years is Dual-coil design and passive fixation leads have
an independent risk predictor for vascular avul- shown to be associated with more fibrous adhe-
sion/tear (OR 3.19; 95% CI 1.21–8.40).16 sions.21 Gated cardiac CT has emerged as a valu-
The indication for extraction should also be able imaging modality to analyze venous stenosis/
considered. Extraction for infection is associated occlusion, lead positioning/course, lead perfora-
with a higher rate of complications during TLE tion, lead fracture, and adhesions.22 The presence
(OR 2.27, 95% CI 1.70–3.04).6 Moreover, in-hospi- of severe lead adhesions (leads with no surround-
tal3 and 30-day all-cause mortality (OR 2.7; 95% ing contrast or blood) was associated with a more
CI: 1.4–5.0)10 are increased when TLE performed complex procedure, including laser sheath size
for device infection. It is unclear whether this is upgrade, longer fluoroscopic time, femoral snare
due to the overall comorbid disease in a patient use, and need for laser and/or mechanical
with infection. In the ELECTRa registry, the pres- sheath.22 Patients with higher lead-to-lead binding
ence of occlusion or critical stenosis of the supe- had more challenging extractions as measured by
rior venous access was an independent predictor extraction time and laser pulses.23 In the recently
for vascular avulsion or tear (OR 5.74; 95% CI published MILES study, cardiac CT with higher
1.71–19.22).16 The presence of targeted leads on fibrosis score predicted need for powered sheath
both right and left sides of chest increases the during extraction.24
risk of acute complications with laser extraction Venography can also be used to assess extent
as well (OR 9.4; 95% CI: 1.6–54.3).17 of lead adhesions. Long adherent segments have
Risk factors specific to extraction of high-voltage been associated with longer fluoroscopy time
cardiac leads include smaller lead diameter, flat and need for power tools.25 In addition, lead-
versus round coil shape, and higher proximal coil related venous stenosis or occlusion on venog-
surface area.6 Implantable cardioverter defibrillator raphy is associated with higher risk of lead fracture
(ICD) leads with an SVC coil are 2.6 times more during extraction, longer procedure time, need for
difficult to remove than single-coil ICD leads and different venous approach, lead-to-lead adhesion,
associated with a significantly higher rate of compli- increased extraction complexity. and the use of
cations18 and a higher 30-day all-cause mortality metallic sheaths and femoral tools.26
(OR 2.7; 95% CI: 1.6–4.5).10 Expanded polytetra- In suspected CIED infection, TEE can aid with
fluoroethylene (ePTFE)-coated ICD leads are resis- the detection of intracardiac thrombi/vegetations
tant to fibrosis and often result in shorter procedure and concomitant tricuspid valvular disease. Open
times and less need for advanced tools19,20 surgical extraction to mitigate thromboembolic
The SAFeTY score was developed to predict the risk if large vegetations (>3.0 cm) present should
risk of procedural complications and need for sur- be considered.27
gical backup for TLE. It includes the patient and Renal function, coagulation, and hemoglobin
device characteristics with sum of lead dwell times levels should be obtained preoperatively. Patients
(S), anemia (A), female sex (Fe), treatment/previ- suspected of having CIED infection should be on
ous procedures (T), and young patients less than the appropriate antibiotics. Anticoagulation man-
30 years (Y). A score of 10 is considered high agement decisions should be made in conjunction
risk and is associated with a 2.5% probability of with CTS. A previous observational study reported
major complications. This increases to greater up to 1.3 increased risk of death and a threefold
than 11.82% in very high-risk patients identified increased risk of major complications in patients
by a score of 16.7 with elevated international normalised ratio
(INR).10 However, others have demonstrated
PREOPERATIVE PREPARATION safety of uninterrupted warfarin with therapeutic
INR and with direct acting oral anticoagulants
Preoperative preparation is a critical component of (DOAC) during extraction.28–30 Anticoagulation
lead extraction procedures. A thorough evaluation protocol during TLE should consider predictors
of the patient’s medical history, comorbidities, de- of thrombotic events such as the presence of me-
vice specifics, and current medication is neces- chanical valve prostheses, atrial fibrillation. The
sary for risk stratification and identifying any current consensus guidelines recommend that

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
122 Igbinomwanhia et al

anticoagulant management be reassessed on a endovascular balloon is the preemptive deploy-

case-by-case basis.31 ment of the balloon to enable rapid advancement
and inflation of the balloon in the event of an SVC
PROCEDURAL PHASE tear, thus reducing deployment time by 90 seconds
and saving appropriately 700 cc of blood loss.44 It
Patients should undergo sterile preparation in case should be noted that the balloon utility is limited
an emergent sternotomy is required, ensuring a to extra pericardial injury of a limited size because
sterile field encompasses the entire front of the if there is injury greater than 80 mm (length of the
chest and femoral regions. Two to four units of balloon), there will be incomplete occlusion.43 Car-
packed red blood cells should be immediately diopulmonary bypass can also be used to tran-
available, especially in cases with higher complica- siently stabilize a patient during an SVC tear
tion risk.31 especially when femoral access has been secured.
An arterial line should be placed to enable inva- Overall, the preoperative and intraoperative
sive blood pressure monitoring and femoral central measures used increase the risk of success and
access obtained to ensure prompt resuscitative survival while improving response times in the
measures in case of SVC tear.32,33 Continuous rare cases that surgical backup is required during
TEE-guided TLE use can increase rates of com- a TLE. These preparations are best served when
plete procedural success and reduce risk of severe protocolized by individuals and institutions to in-
complications, ultimately preventing periproce- crease the success of lead extractions.
dural deaths.34 TEE also aids in monitoring hemo-
dynamics, adjusting vasoactive medications and SUMMARY
promptly identifies complications leading to a time-
lier intervention. Intracardiac echocardiography These cases describe the safety measures taken
(ICE) has emerged as another valuable tool in TLE in preparation for complications from laser lead
for demonstrating fibrotic areas, lead adhesions, extractions, which are rare but can cause signifi-
and presence of any remaining lead fragments or cant morbidity and mortality. The risk assessment
remnants. However, the use of ICE during extrac- of patient and device characteristics along with
tion requires a second operator and its presence assessment of imaging studies, comorbidities,
in the RA may limit space for necessary tools.35 and laboratory work can be critical in preoperative
Shockwave intravascular lithotripsy is a novel tech- assessment of patient. The preparation enacted to
nique that was recently explored as an adjunct to prevent complications or to mitigate loss of time in
pretreat vessels with dense calcification via shock the event of complications are crucial to a suc-
wave therapy. It was shown to reduce procedural cessful program.
time by 25 minutes.36
There are no established guidelines regarding CLINICS CARE POINTS
the ideal setting (such as an electrophysiology
suite or hybrid OR) for TLE, nor are there specific
recommendations regarding the level of surgical
backup needed. Common practices include selec-  Patient-related risk factors for superior vena
tion of low-risk patients for electrophysiology suite, cava injury during transvenous lead extrac-
tion include female sex, low body mass index,
whereas moderate to high-risk candidates may
diabetes mellitus, renal failure, severe left
undergo TLE in the hybrid suite or OR.15,37–40 The ventricular dysfunction, and anemia.
shoulder-to-shoulder approach (co-operator with
a cardiac surgeon) has been shown to improve  The procedure-related risk factors for supe-
rior vena cava injury during transvenous
procedural success but with no mortality
lead extraction include presence of superior
benefit.41,42 Regardless of the setting, TLE should vena cava occlusion or stenosis and presence
be done in a location that will allow for emergent of device infection.
sternotomy or thoracotomy within 5 to 10 minutes
 Device-related risk factors for superior vena
of a complication.42
cava injury during transvenous lead extrac-
In the event of an SVC tear or injury, it is crucial to tion include lead type and duration of im-
stabilize the patient in preparation for emergency plantation and number of leads implanted.
surgical repair. The use of endovascular occlusion
 Preoperative preparation and a multidisci-
balloon can serve as a bridging technique. Extrac-
plinary approach to transvenous lead extrac-
tion complicated by SVC tear with successful tion can lead to timely and optimal
deployment of occlusion balloon was associated management of complications including su-
with an 87% reduction of in-hospital mortality.43 perior vena cava injury.
Another emerging practice in the use of

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
 Case Series and Review of Literature 123

REFERENCES 14. Tu1ecki q, Polewczyk A, Jachec  W, et al. Analysis of

risk factors for major complications of 1500 transve-
1. Perez AA, Woo FW, Tsang DC, et al. Transvenous lead nous lead extraction procedures with especial atten-
extractions: current approaches and future trends. tion to tricuspid valve damage. Int J Environ Res
Arrhythm Electrophysiol Rev 2018;7(3):210–7. Public Health 2021;18(17):9100. Published 2021
2. Deshmukh A, Patel N, Noseworthy PA, et al. Trends Aug 28.
in use and adverse outcomes associated with trans- 15. Fu HX, Huang XM, Zhong LI, et al. Outcomes and
venous lead removal in the United States. Circula- complications of lead removal: can we establish a
tion 2015;132(25):2363–71. risk stratification schema for a collaborative and
3. Wazni O, Epstein LM, Carrillo RG, et al. Lead extrac- effective approach? [published correction appears
tion in the contemporary setting: the LExICon study: in pacing clin electrophysiol. 2016 Feb;39(2):205.
an observational retrospective study of consecutive Pacing Clin Electrophysiol 2015;38(12):1439–47.
laser lead extractions [published correction appears 16. Zucchelli G, Di Cori A, Segreti L, et al. Major cardiac
in J Am Coll Cardiol. 2010 Mar 9;55(10):1055]. J Am and vascular complications after transvenous lead
Coll Cardiol 2010;55(6):579–86. extraction: acute outcome and predictive factors
4. Arora Y, D’Angelo L, Azarrafiy R, et al. Location of from the ESC-EHRA ELECTRa (European Lead
superior vena cava tears in transvenous lead extrac- Extraction ConTRolled) registry. Europace 2019;
tion. Ann Thorac Surg 2022;113(4):1165–71. 21(5):771–80.
5. Bashir J, Lee AJ, Philippon F, et al. Predictors of 17. Roux JF, Pagé P, Dubuc M, et al. Laser lead extrac-
perforation during lead extraction: results of the Ca- tion: predictors of success and complications. Pac-
nadian lead ExtrAction risk (CLEAR) study. Heart ing Clin Electrophysiol 2007;30(2):214–20.
Rhythm 2022;19(7):1097–103. 18. Epstein LM, Love CJ, Wilkoff BL, et al. Superior vena
6. Sood N, Martin DT, Lampert R, et al. Incidence and cava defibrillator coils make transvenous lead
predictors of perioperative complications with trans- extraction more challenging and riskier. J Am Coll
venous lead extractions: real-world experience with Cardiol 2013;61(9):987–9.
national cardiovascular data registry. Circ Arrhythm 19. Kohut AR, Grammes J, Schulze CM, et al. Percuta-
Electrophysiol 2018;11(2):e004768. neous extraction of ePTFE-coated ICD leads: a sin-
7. Jachec  W, Polewczyk A, Polewczyk M, et al. Trans- gle center comparative experience. Pacing Clin
venous lead extraction safety score for risk stratifica- Electrophysiol 2013;36(4):444–50.
tion and proper patient selection for removal 20. Di Cori A, Bongiorni MG, Zucchelli G, et al. Transve-
procedures using mechanical tools. J Clin Med nous extraction performance of expanded polytetra-
2020;9(2):361. fluoroethylene covered ICD leads in comparison to
8. Byrd CL, Wilkoff BL, Love CJ, et al. Clinical study of traditional ICD leads in humans. Pacing Clin Electro-
the laser sheath for lead extraction: the total experi- physiol 2010;33(11):1376–81.
ence in the United States. Pacing Clin Electrophysiol 21. Segreti L, Di Cori A, Soldati E, et al. Major predictors
2002;25(5):804–8. of fibrous adherences in transvenous implantable
9. Jachec  W, Polewczyk A, Polewczyk M, et al. Risk cardioverter-defibrillator lead extraction. Heart
factors predicting complications of transvenous Rhythm 2014;11(12):2196–201.
lead extraction. BioMed Res Int 2018;2018:8796704. 22. Svennberg E, Jacobs K, McVeigh E, et al.
10. Brunner MP, Cronin EM, Duarte VE, et al. Clinical Computed tomography-guided risk assessment in
predictors of adverse patient outcomes in an expe- percutaneous lead extraction. JACC Clin Electro-
rience of more than 5000 chronic endovascular physiol 2019;5(12):1439–46.
pacemaker and defibrillator lead extractions. Heart 23. Beaser AD, Aziz Z, Besser SA, et al. Characterization
Rhythm 2014;11(5):799–805. of lead adherence using intravascular ultrasound to
11. Barakat AF, Wazni OM, Tarakji KG, et al. Transve- assess difficulty of transvenous lead extraction. Circ
nous lead extraction in chronic kidney disease and Arrhythm Electrophysiol 2020;13(8):e007726.
dialysis patients with infected cardiac devices. 24. Patel D, Vatterott P, Piccini J, et al. Prospective eval-
Circ Arrhythm Electrophysiol 2018;11(1):e005706. uation of the correlation between gated cardiac
12. Aleong RG, Zipse MM, Tompkins C, et al. Analysis of computed tomography detected vascular fibrosis
outcomes in 8304 patients undergoing lead extrac- and ease of transvenous lead extraction. Circ Ar-
tion for infection. J Am Heart Assoc 2020;9(7): rhythm Electrophysiol 2022;15(11):e010779.
e011473. 25. Aboelhassan M, Bontempi L, Cerini M, et al. The role
13. Byrd CL, Wilkoff BL, Love CJ, et al. Intravascular of preoperative venography in predicting the diffi-
extraction of problematic or infected permanent culty of a transvenous lead extraction procedure.
pacemaker leads: 1994-1996. U.S. Extraction Data- J Cardiovasc Electrophysiol 2022;33(5):1034–40.
base, MED Institute. Pacing Clin Electrophysiol 26. Czajkowski M, Jachec  W, Polewczyk A, et al. The in-
1999;22(9):1348–57. fluence of lead-related venous obstruction on the

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
124 Igbinomwanhia et al

complexity and outcomes of transvenous lead 36. Latanich CA, Anderson JA. Shockwave intravascular
extraction. Int J Environ Res Public Health 2021; lithotripsy facilitated transvenous lead extraction.
18(18):9634. JACC Clin Electrophysiol 2023;9(8 Pt 2):1585–92.
27. Wilkoff BL, Love CJ, Byrd CL, et al. Transvenous 37. Franceschi F, Dubuc M, Deharo JC, et al. Extraction
lead extraction: heart Rhythm Society expert of transvenous leads in the operating room versus
consensus on facilities, training, indications, and pa- electrophysiology laboratory: a comparative study.
tient management: this document was endorsed by Heart Rhythm 2011;8(7):1001–5.
the American Heart Association (AHA). Heart
38. Sidhu BS, Ayis S, Gould J, et al. Risk stratification of
Rhythm 2009;6(7):1085–104.
patients undergoing transvenous lead extraction
28. Zheng Q, Maytin M, John RM, et al. Transvenous
with the ELECTRa Registry Outcome Score
lead extraction during uninterrupted warfarin ther-
(EROS): an ESC EHRA EORP European lead extrac-
apy: feasibility and outcomes. Heart Rhythm 2018;
tion ConTRolled ELECTRa registry analysis. Euro-
15(12):1777–81.
pace 2021;23(9):1462–71.
29. Vinit S, Vanessa C, Alexander B, et al. Transvenous
lead extraction on uninterrupted anticoagulation: a 39. Kancharla K, Acker NG, Li Z, et al. Efficacy and
safe approach? Indian Pacing Electrophysiol J safety of transvenous lead extraction in the device
2021;21(4):201–6. laboratory and operating room guided by a novel
30. Issa ZF, Elayyan MAM. Outcome of transvenous risk stratification scheme. JACC Clin Electrophysiol
lead extraction in patients on minimally interrupted 2019;5(2):174–82.
periprocedural direct oral anticoagulation therapy. 40. Bontempi L, Vassanelli F, Cerini M, et al. Predicting
J Cardiovasc Electrophysiol 2021;32(10):2722–8. the difficulty of a lead extraction procedure: the
31. Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. LED index. J Cardiovasc Med 2014;15(8):668–73.
2017 HRS expert consensus statement on cardio- 41. Roberto M, Sicuso R, Manganiello S, et al. Cardiac
vascular implantable electronic device lead man- surgeon and electrophysiologist shoulder-to-
agement and extraction [published correction shoulder approach: hybrid room, a kingdom for two.
appears in Heart Rhythm. 2021 Oct;18(10):1814. A zero mortality transvenous lead extraction single
Heart Rhythm 2017;14(12):e503–51. center experience. Int J Cardiol 2019;279:35–9.
32. Goya M, Nagashima M, Hiroshima K, et al. Lead ex-
42. Kosior J, Jachec W, Polewczyk A, et al. To grade or
tractions in patients with cardiac implantable elec-
not to grade safety requirements for transvenous
tronic device infections: single center experience.
lead extraction: experience with 2216 procedures.
J Arrhythm 2016;32(4):308–12.
Kardiol Pol 2023;81(3):242–51.
33. Hussein AA, Wilkoff BL. Transvenous lead extraction of
cardiac implantable electronic devices: who, when, 43. Azarrafiy R, Tsang DC, Wilkoff BL, et al. Endovascu-
how and where? Rev Esp Cardiol 2016;69(1):3–6. lar occlusion balloon for treatment of superior vena
34. Nowosielecka D, Jachec  W, Polewczyk A, et al. cava tears during transvenous lead extraction: a
Transesophageal echocardiography as a monitoring multiyear analysis and an update to best practice
tool during transvenous lead extraction-does it protocol. Circ Arrhythm Electrophysiol 2019;12(8):
improve procedure effectiveness? J Clin Med e007266.
2020;9(5):1382. 44. Tsang DC, Azarrafiy R, Pecha S, et al. Long-term
35. Caiati C, Luzzi G, Pollice P, et al. A novel clinical outcomes of prophylactic placement of an endovas-
perspective on new masses after lead extraction cular balloon in the vena cava for high-risk transve-
(ghosts) by means of intracardiac echocardiogra- nous lead extractions. Heart Rhythm 2017;14(12):
phy. J Clin Med 2020;9(8):2571. 1833–8.

Downloaded for Carlos Hernan Castaneda Ruiz (cas.memi1966@gmail.com) at University of KwaZulu-Natal from ClinicalKey.com by
Elsevier on July 21, 2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.