Persistent left superior vena cava transvenous lead extraction: A European experience. (22nd November 2021)

• Record Type: Journal Article
• Authors: Akhtar, Zaki; Sohal, Manav; Starck, Christoph T.; Mazzone, Patrizio; Melillo, Francesco; Gonzalez, Elkin; Al‐Razzo, Omar; Richter, Sergio; Breitenstein, Alexander; Steffel, Jan; Rinaldi, Christopher A.; Mehta, Vishal; Zuberi, Zia; Zaidi, Amir; Gallagher, Mark M.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 33:Number 1(2022)
• Page Start: 102
• Page End: 108
• Publication Date: 2021-11-22
• Subjects: cardiac implantable electronic devices -- persistent left superior vena cava -- transvenous lead extraction; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15290
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Background: Transvenous lead extraction (TLE) is rising in parallel to cardiac implantable electronic device implantations. Persistent left side superior vena cava (PLSVC) is a relatively common anatomical variant in the healthy population; TLE in patients with a PLSVC is rare. Method: Data were collated from 6 European TLE institutes of 10 patients who had undergone lead extraction with a PLSVC. Patient demographics, procedural challenges and outcomes were reported. Results: Ten patients aged 73.4 ± 7.8 years (60% male) underwent TLE of 20 leads (3 left ventricle, 10 right ventricle, 7 right atrium) with dwell time of 82.95 ± 39.1 months. Of the 10 cases, 4 had an infection indication and 5 were biventricular system extractions; 25% of the extracted leads were defibrillator leads. The majority of the procedures were completed in the cardiac catheterization suite (80%) under general anaesthesia (60%) by cardiologists (80%) using a rotational powered sheath (65%). The Tandem approach was used successfully in 3 cases. Complete procedural success was obtained in 100% of cases in the absence of complications within 127.4 ± 74.7 min. There was no 30‐day mortality. Conclusion: TLE in PLSVC is feasible albeit rare. Standard extraction techniques in experienced hands are associated with favorable outcomes; the Tandem procedure may be an additional technique to improve the safety and efficacy of TLE in PLSVC.