Clinical Experiences in Lead Extraction

  • Ezio Soldati
  • Maria Grazia Bongiorni


Since the development of effective techniques for transvenous removal of permanent pacing leads, a large volume of experience regarding clinical results of these techniques has been published [1]. The development of different techniques, mainly differing due to the type of energy used for dilatation, raised the debate about their relative superiority. As always happens when clinical results have to be analyzed, evaluated, and compared with different experiences, it is difficult to assess the relative importance of the technique itself, operator skill and experience, and how those procedures and their results are applicable to physicians and clinical practice in their particular field of interest. This general observation is particularly important with regard to transvenous lead extraction.


Cardiac Resynchronization Therapy Superior Vena Cava Left Ventricular Lead Lead Removal Lead Extraction 
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  1. 1.
    Byrd CL, Schwartz SJ, Hedin NB et al (1990) Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 13:1871–1875PubMedCrossRefGoogle Scholar
  2. 2.
    Love CJ, Wilkoff BL, Byrd CL et al (2000) Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 23(4 Pt 1):544–551PubMedGoogle Scholar
  3. 3.
    Wilkoff BL, Love CJ, Byrd CL et al (2009) Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training indications and patient management. Heart Rhythm 6:1086–1104CrossRefGoogle Scholar
  4. 4.
    Love CJ (2000) Current concepts in extraction of transvenous pacing and ICD leads. Cardiol Clin 18:193–217PubMedCrossRefGoogle Scholar
  5. 5.
    Verma A, Wilkoff BL (2004) Intravascular pacemaker and defibrillator lead extraction: a state-of-the-art review. Heart Rhythm 1:739–745PubMedCrossRefGoogle Scholar
  6. 6.
    Furman S, Behrens M, Andrews C, Klementowicz P (1987) Retained pacemaker leads. J Thoracic Cardiovasc Surg 94:770–772Google Scholar
  7. 7.
    Parry G, Goudevenos J, Jameson S et al (1991) Complications associated with retained pacemaker leads. Pacing Clin Electrophysiol 14:1251–1257PubMedCrossRefGoogle Scholar
  8. 8.
    Zerbe F, Ponizynski A, Dyszkiewicz W et al (1985) Functionless retained pacing leads in the cardiovascular system. Br Heart J 54:76–79PubMedCrossRefGoogle Scholar
  9. 9.
    Byrd CL, Schwartz SJ, Hedin NB et al (1990) Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 13:1871–1875PubMedCrossRefGoogle Scholar
  10. 10.
    Eckhard A, Neuzner J, Binner L (1996) Three-year experience with a stylet for lead extraction: a multicenter study. Pacing Clin Electrophysiol 19:18–25CrossRefGoogle Scholar
  11. 11.
    Vassilikos VP, Maounis TN, Chiladakis J et al (1999) Percutaneous extraction of transvenous defibrillator leads using the VascoExtor pacing lead removal system. J Interv Card Electrophysiol 3(3):247–251PubMedCrossRefGoogle Scholar
  12. 12.
    Bracke F, Meijer A, Van Gelder B (2002) Extraction of pacemaker and implantable defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools. Pacing Clin Electrophysiol 25(7):1037–1040PubMedCrossRefGoogle Scholar
  13. 13.
    Bracke FA, Meijer A, Van Gelder LM (2004) Lead extraction for device related infections: a single centre experience. Europace 6:243–247PubMedCrossRefGoogle Scholar
  14. 14.
    Marijon E, Boveda S, De Guillebon M et al (2009) Contribution of advanced techniques to the success and safety of transvenous lead extraction. Pacing Clin Electrophysiol 32(Suppl 1):S38–S41PubMedCrossRefGoogle Scholar
  15. 15.
    Byrd CL, Schwartz SJ, Hedin NB (1991) Intravascular techniques for extraction of permanent pacemakers leads. J Thoracic Cardiovasc Surg 101:989–997Google Scholar
  16. 16.
    Smith HJ, Fearnot NE, Byrd CL et al (1994) Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. Pacing Clin Electrophysiol 17(11 Pt 2): 2016–2020PubMedCrossRefGoogle Scholar
  17. 17.
    Byrd CL, Wilkoff BL, Love CJ et al (1999) Intravascular extraction of problematic or infected permanent pacemaker leads: 1994–1996. U.S. Lead Extraction Database, Med Institute. Pacing Clin Electrophysiol 22(9):1348–1357PubMedCrossRefGoogle Scholar
  18. 18.
    Mathur G, Stables RH, Heaven D et al (2003) Cardiac pacemaker lead extraction using conventional technique: a single centre experience. Int J Cardiol 91(2–3):215–219PubMedCrossRefGoogle Scholar
  19. 19.
    Bongiorni MG, Giannola G, Soldati E et al (2005) Pacing and implantable cardioverter-defibrillator transvenous lead extraction. Ital Heart J 6:261–266PubMedGoogle Scholar
  20. 20.
    Bongiorni MG, Soldati E, Zucchelli G et al (2008) Transvenous removal of pacing and defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads. Eur Heart J 29(23):2886–2893PubMedCrossRefGoogle Scholar
  21. 21.
    Wilkoff BL, Byrd CL, Love CJ et al (1999) Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol 1999; 33:1671–1676CrossRefGoogle Scholar
  22. 22.
    Byrd CL, Wilkoff BL, Love CJ et al (2002) Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol 25:804–808PubMedCrossRefGoogle Scholar
  23. 23.
    Kennergren C (1997) Initial European experience with excimer laser assisted extraction of permanent pacemaker leads. Pacing Clin Electrophysiol 20:4(Pt. II): 1111 [abstract]Google Scholar
  24. 24.
    Kennergren C, Bucknall CA, Butter C et al (2007) PLESSE investigators group. Laser assisted lead extraction: the European experience. Europace 9(8):651–656PubMedCrossRefGoogle Scholar
  25. 25.
    Moon MR, Camillo CJ, Gleva MJ (2002) Laser-assist during extraction of chronically implanted pacemaker and defibrillator leads. Ann Thorac Surg 73:1893–1896PubMedCrossRefGoogle Scholar
  26. 26.
    Roux JF, Pagé P, Dubuc M et al (2007) Laser lead extraction: predictors of success and complications. Pacing Clin Electrophysiol 30(2):214–220PubMedCrossRefGoogle Scholar
  27. 27.
    Jones SO, Eckart RE, Albert CM, Epstein LM (2008) Large, single-centre, single-operator experience with transvenous lead extraction: outcomes and changing indications. Heart Rhythm 5(4):520–525PubMedCrossRefGoogle Scholar
  28. 28.
    Kennergren C, Bjurman C, Wiklund R, Gabel J (2009) A single-centre experience of over one thousand lead extractions. Europace 11(5):612–617PubMedCrossRefGoogle Scholar
  29. 29.
    Wazni O, Epstein LM, Carrillo RG et al (2010) Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 55(6):579–586PubMedCrossRefGoogle Scholar
  30. 30.
    Wilkoff BL (2000) Transvenous leads extraction with electrosurgical dissection sheaths. Initial experience. Pacing Clin Electrophysiol 23:679–684Google Scholar
  31. 31.
    Neuzil P, Taborsky M, Rezek K et al (2007) Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. Europace 9(2):98–104PubMedCrossRefGoogle Scholar
  32. 32.
    Schaerf R, Norlander B, Goode L (2008) Clinical experience with the Evolution mechanical dilator sheath set for intravascular lead extraction at a single center. Heart Rhythm 5:S338Google Scholar
  33. 33.
    Dello Russo A, Biddau R, Pelargonio G et al (2009) Lead extraction: a new effective tool to overcome fibrous binding sites. J Interve Cardiac Electrophysiol 24:147–150CrossRefGoogle Scholar
  34. 34.
    Hauser RG, Katsiyiannis W, Gornik C (2010) Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction. Europace 12:395–341PubMedCrossRefGoogle Scholar
  35. 35.
    Hussein A, Wilkoff B, Martin D (2010) Initial experience with the Evolution mechanical dilator sheath for lead extraction: safety and efficacy. Heart Rhythm 7(7):874–875CrossRefGoogle Scholar
  36. 36.
    Byrd CL, Schwartz SJ, Hedin NB (1992) Lead extraction: indications and techniques. Cardiol Clin 10: 735–748PubMedGoogle Scholar
  37. 37.
    Love CJ (2007) Lead extraction. Heart Rhythm 4(9):1238–1243PubMedCrossRefGoogle Scholar
  38. 38.
    Jarwe M, Klug D, Beregi JP et al (1999) Single center experience with femoral extraction of permanent endocardial pacing. Pacing Clin Electrophysiol 1999;22:1202–1209PubMedCrossRefGoogle Scholar
  39. 39.
    Le Franc P, Klug D, Jarwe M et al (1999) Extraction of endocardial implantable cardioverter-defibrillator leads. Am J Cardiol 84(2):187–191PubMedCrossRefGoogle Scholar
  40. 40.
    Klug D, Jarwe M, Messaoudène SA et al (2002) Pacemaker lead extraction with the needle’s eye snare for countertraction via a femoral approach. Pacing Clin Electrophysiol 25:1023–1028PubMedCrossRefGoogle Scholar
  41. 41.
    Bordachar P, Defaye P, Peyrouse E et al (2010) Extraction of old pacemaker or cardioverter defibrillator leads by laser sheath versus femoral approach. Circ Arrhythm Electrophysiol 3(4):319–323PubMedCrossRefGoogle Scholar
  42. 42.
    Kennergren C (2008) European perspective on lead extraction. Part II. Heart Rhythm 5(2):320–323CrossRefGoogle Scholar
  43. 43.
    Mazzetti H, Cichero CF, Tentori MC, Mascheroni O (2008) Transjugular approach for lead extraction. Europace 10(2):156–160PubMedCrossRefGoogle Scholar
  44. 44.
    Kleemann T, Becker T, Doenges K et al (2007) Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation 115(19):2474–2480PubMedCrossRefGoogle Scholar
  45. 45.
    Epstein LM, Byrd CL, Wilkoff BL et al (1999) Initial experience with larger laser sheaths for the removal of transvenous pacemaker and implantable defibrillator leads. Circulation 100:516–525PubMedCrossRefGoogle Scholar
  46. 46.
    Kantharia BK, Padder FA, Pennington JC 3rd et al (2000) Feasibility, safety, and determinants of extraction time of percutaneous extraction of endocardial implantable cardioverter defibrillator leads by intravascular countertraction method. Am J Cardiol 85:593–597PubMedCrossRefGoogle Scholar
  47. 47.
    Saad EB, Saliba WI, Schweikert RA et al (2003) Nonthoracotomy implantable defibrillator lead extraction: results and comparison with extraction of pacemaker leads. Pacing Clin Electrophysiol 26:1944–1950.PubMedCrossRefGoogle Scholar
  48. 48.
    McAlister FA, Ezekowitz J, Hooton N et al (2007) Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA 297(22):2502–2514PubMedCrossRefGoogle Scholar
  49. 49.
    De Martino G, Orazi S, Bisignani G et al (2005) Safety and Feasibility of Coronary Sinus left ventricular pacing leads extraction: a preliminary report. J Interv Card Electrophysiol 13(1):35–38.PubMedCrossRefGoogle Scholar
  50. 50.
    Kasravi B, Tobias S, Barnes M, Messenger J (2005) Coronary sinus leads extraction in the era of cardiac resynchronization therapy: single centre experience. Pacing Clin Electrophysiol 28(1):51–53PubMedCrossRefGoogle Scholar
  51. 51.
    Bracke F (2008) Complications and lead extraction in cardiac pacing and defibrillation. Neth Heart J 16(Suppl 1):S28–S31PubMedGoogle Scholar
  52. 52.
    Tyers GF, Clark J, Wang Y et al (2003) Coronary sinus leads extraction. Pacing Clin Electrophysiol 26(1 Pt 2):524–526PubMedGoogle Scholar
  53. 53.
    Bongiorni MG, Zucchelli G, Soldati E et al (2007) Usefulness of mechanical transvenous dilatation and location of areas of adherence in patients undergoing coronary sinus lead extraction. Europace 9:69–73PubMedCrossRefGoogle Scholar
  54. 54.
    Bongiorni MG, Di Cori A, Zucchelli G et al (2010) A modified transvenous single mechanical dilatation technique to remove a chronically implanted active-fixation coronary sinus pacing lead. PACE 2010 33:1376–1381Google Scholar
  55. 55.
    Makaryus AN, Boutis L, Goldner B, Park CH (2007) Coronary sinus angioplasty and stenting for biventricular pacemaker left ventricular lead implantation. J Invasive Cardiol 19(5):E128–E130PubMedGoogle Scholar
  56. 56.
    Kowalski O, Lenarczyk R, Prokopczuk J et al (2006) Effects of percutaneous intervention within the coronary sinus on the success rate of implantations of resynchronization pacemakers. Pacing Clin Electrophysiol 29(10):1075–1080PubMedCrossRefGoogle Scholar
  57. 57.
    Cesario DA, Shenoda M, Brar R, Shivkumar K (2006) Left ventricular lead stabilization utilizing a coronary stent. Pacing Clin Electrophysiol 29(4):427–428PubMedCrossRefGoogle Scholar
  58. 58.
    Bongiorni MG, Soldati E, Arena G et al (1999) Transvenous removal of permanent electrocatheters for heart stimulation and defibrillation. Cardiologia 44(Suppl 1 Pt 1):395–398PubMedGoogle Scholar
  59. 59.
    Robboy SJ, Harthorne JW, Leinbach RC et al (1969) Autopsy findings with permanent pervenous pacemakers. Circulation 39:495–501PubMedCrossRefGoogle Scholar
  60. 60.
    Lin G, Nishimura RA, Connolly HM et al (2005) Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads. J Am Coll Cardiol 45(10):1672–1675PubMedCrossRefGoogle Scholar
  61. 61.
    Gaynor SL, Zierer A, Lawton JS et al (2006) Laser assistance for extraction of chronically implanted endocardial leads: infectious versus noninfectious indications. Pacing Clin Electrophysiol 29(12):1352–1358PubMedCrossRefGoogle Scholar
  62. 62.
    Agarwal SK, Kamireddy S, Nemec J et al (2009) Predictors of complications of endovascular chronic lead extractions from pacemakers and defibrillators: a single-operator experience. J Cardiovasc Electrophysiol 20(2):171–175PubMedCrossRefGoogle Scholar
  63. 63.
    Franceschi F, Thuny F, Giorgi R (2009) Incidence, risk factors, and outcome of traumatic tricuapid regurgitation after percutaneous ventricular lead removal. J Am Coll Cardiol 53(23):2168–2174PubMedCrossRefGoogle Scholar
  64. 64.
    Meier-Ewert HK, Gray ME, John RM (2003) Endocardial pacemaker or defibrillator leads with infected vegetations: a single-center experience and consequences of transvenous extraction. Am Heart J 146(2):339–344PubMedCrossRefGoogle Scholar
  65. 65.
    Ruttmann E, Hangler HB, Kilo J et al (2006) Transvenous pacemaker lead removal is safe and effective even in large vegetations: an analysis of 53 cases of pacemaker lead endocarditis. Pacing Clin Electrophysiol 29(3):231–236PubMedCrossRefGoogle Scholar
  66. 66.
    Wilkoff BL (2007) How to treat and identify device infections. Heart Rhythm 4(11):1467–1470PubMedCrossRefGoogle Scholar
  67. 67.
    Hamid S, Arujuna A, Ginks M et al (2010) Pacemaker and defibrillator lead extraction: predictors of mortality during follow-up. Pacing Clin Electrophysiol 33(2):209–216PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Ezio Soldati
    • 1
  • Maria Grazia Bongiorni
    • 1
  1. 1.2nd Cardiovascular Department AOUPSanta Chiara University HospitalPisaItaly

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