eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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3/2019
vol. 15
 
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abstract:
Original paper

Safety and effectiveness of coronary sinus leads extraction – single high-volume centre experience

Andrzej W. Kutarski
1
,
Wojciech Jacheć
2
,
Łukasz Tułecki
3
,
Konrad Tomków
3
,
Paweł Stefańczyk
4
,
Wojciech Borzęcki
4
,
Dorota Nowosielecka
4
,
Marek Czajkowski
5
,
Maciej Polewczyk
6, 7
,
Anna Polewczyk
6, 8

  1. Cardiology Department, Medical University of Lublin, Lublin, Poland
  2. 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
  3. Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamość, Poland
  4. Department of Cardiology, The Pope John Paul II Province Hospital, Zamość, Poland
  5. Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
  6. Department of Medicine and Health Studies, Jan Kochanowski University, Kielce, Poland
  7. Acute Cardiac Care Unit, Swietokrzyskie Cardiology Center, Kielce, Poland
  8. Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce Poland
Adv Interv Cardiol 2019; 15, 3 (57): 345–356
DOI: https://doi.org/10.5114/aic.2019.87890
Online publish date: 2019/09/18
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Introduction
Transvenous leads extraction (TLE) of permanently implanted coronary sinus (CS) leads is widely believed to present greater risks than the removal of other leads.

Aim
To assess the safety and efficacy of CS leads extraction based on large research material obtained by one operator performing procedures in two TLE centres.

Material and methods
We extracted 408 CS leads from 389 patients, and the results were compared to a control group of 2465 patients who underwent non-CS lead TLE procedures.

Results
There were no significant differences in the clinical success rate (97.9% vs. 98.0%) or the major complication rate (2.1% vs. 1.8%) between the CS and control group. CS lead destination (LV/LA pacing) and tip location (CS ostium/mid CS /CS tributaries) influenced the procedural and radiological success rates and procedural complexity but not the complications. CS lead extraction did not affect the necessity for a cardiosurgical intervention or presence of procedure-related death.

Conclusions
TLE of CS leads can be achieved with a high procedural success rate. The major complication rate is not higher than that seen in non-CS lead extraction patients. More than half of CS leads cannot be removed by simple traction and the use of mechanical sheaths may be necessary. The detachment of CS leads from connective tissue scars in the venous and atrial areas up to the CS ostium is generally sufficient for further removal of the lead using simple traction.

keywords:

coronary sinus lead extraction, transvenous lead extraction, cardiac veins
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