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Publications

Journal Article Epublish 2 citations

PubMed: 36312249 DOI: 10.3389/fcvm.2022.1016657

Occluded vein as a predictor for complications in non-infectious transvenous lead extraction.

Front Cardiovasc Med 9:1016657

Authors: Anat Milman, Eran Leshem, Eias Massalha, Karen Jia, Amit Meitus, Saar Kariv, Yuval Shafir, Michael Glikson, David Luria, Avi Sabbag, Roy Beinart, Eyal Nof

Affiliations

  • Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel.
  • Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
  • Hebrew University in Jerusalem Medical School, Jerusalem, Israel.
  • Hadassah Medical Center, Heart Institute, Jerusalem, Israel.

Abstract

Background

The use of cardiovascular implantable electronic device (CIED) is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous lead extraction (TLE) can facilitate the re-implantation of new leads.

Aims

This study aims to explore predictors and complications of non-infectious TLE.

Methods

This study involves a retrospective analysis and comparison of characteristics, complications, and outcomes of patients with and without occluded veins (OVs) undergoing TLE at our center.

Results

In total, eighty-eight patients underwent TLE for non-infectious reasons. Indications for TLE were lead malfunction (62; 70.5%) and need for CIED upgrade (22; 25%). Fourteen patients referred due to lead malfunction had an OV observed during venography. The OV group (36 patients) were significantly older (65.7 ± 14.1 vs. 53.8 ± 15.9, = 0.001) and had more comorbidities. Ejection fraction (EF) was significantly lower for the OV group (27.5 vs. 57.5%, = 0.001) and had a longer lead dwelling time (3,226 ± 2,324 vs. 2,191 ± 1,355 days, = 0.012). Major complications were exclusive for the OV group (5.5% vs. none, = 0.17), and most minor complications occurred in the OV group as well (33.3 vs. 4.1%, < 0.001). Laser sheath and mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4 vs. 73.5%, respectively, = 0.012). Procedure success was higher in the non-occluded group compared to the OV group (98 vs. 83.3%, respectively, = 0.047). Despite these results, periprocedural mortality was similar between groups.

Conclusion

Among the TLE for non-infectious reasons, vein occlusion appears as a major predictor of complex TLE tool use, complications, and procedural success. Venography should be considered prior to non-infectious TLE to identify high-risk patients.

MeSH

Phlebography, Veins