Benefits of routine prophylactic femoral access during transvenous lead extraction
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Benefits of routine prophylactic femoral access during transvenous lead extraction. / Chung, Da-Un; Müller, Lisa; Ubben, Timm; Yildirim, Yalin; Petersen, Johannes; Sinning, Christoph; Castro, Liesa; Demal, Till Joscha; Kaiser, Lukas; Gosau, Nils; Reichenspurner, Hermann; Willems, Stephan; Pecha, Simon; Hakmi, Samer.
In: HEART RHYTHM, Vol. 18, No. 6, 06.2021, p. 970-976.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Benefits of routine prophylactic femoral access during transvenous lead extraction
AU - Chung, Da-Un
AU - Müller, Lisa
AU - Ubben, Timm
AU - Yildirim, Yalin
AU - Petersen, Johannes
AU - Sinning, Christoph
AU - Castro, Liesa
AU - Demal, Till Joscha
AU - Kaiser, Lukas
AU - Gosau, Nils
AU - Reichenspurner, Hermann
AU - Willems, Stephan
AU - Pecha, Simon
AU - Hakmi, Samer
N1 - Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND: The number of patients requiring lead extraction has been increasing in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. Prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in the event of complications.OBJECTIVE: The purpose of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing transvenous lead extraction (TLE) and to evaluate the methods, frequency, and efficacy of the emergency measures used in those patients.METHODS: We conducted a retrospective analysis of patients who underwent TLE from January 2012 to February 2019. The data were analyzed with regard to procedural complications and deployment of emergency measures via femoral access.RESULTS: Two hundred eighty-five patients (mean age 65.3 ± 15.5 years) were included in the study. Median lead dwell time was 84 months (interquartile range 58-144). Overall complication rate was 4.2% (n = 12), with 1.8% major complications (n = 5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n = 3). Femoral sheaths were actively engaged in 9.1% (n = 26) of cases. Deployment of snares was the most common intervention (n = 10), followed by prophylactic (n = 6) or emergency placement (n = 1) of occlusion balloons, temporary pacing (n = 3), venous angioplasty (n = 3), diagnostic venography (n = 3), and extracorporeal membrane oxygenation (n = 1). We did not observe any femoral vascular complications due to prophylactic sheath placement.CONCLUSION: Routine prophylactic placement of femoral sheaths shortens response time and quickly establishes control in the event of various complications that may occur during TLE procedures.
AB - BACKGROUND: The number of patients requiring lead extraction has been increasing in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. Prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in the event of complications.OBJECTIVE: The purpose of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing transvenous lead extraction (TLE) and to evaluate the methods, frequency, and efficacy of the emergency measures used in those patients.METHODS: We conducted a retrospective analysis of patients who underwent TLE from January 2012 to February 2019. The data were analyzed with regard to procedural complications and deployment of emergency measures via femoral access.RESULTS: Two hundred eighty-five patients (mean age 65.3 ± 15.5 years) were included in the study. Median lead dwell time was 84 months (interquartile range 58-144). Overall complication rate was 4.2% (n = 12), with 1.8% major complications (n = 5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n = 3). Femoral sheaths were actively engaged in 9.1% (n = 26) of cases. Deployment of snares was the most common intervention (n = 10), followed by prophylactic (n = 6) or emergency placement (n = 1) of occlusion balloons, temporary pacing (n = 3), venous angioplasty (n = 3), diagnostic venography (n = 3), and extracorporeal membrane oxygenation (n = 1). We did not observe any femoral vascular complications due to prophylactic sheath placement.CONCLUSION: Routine prophylactic placement of femoral sheaths shortens response time and quickly establishes control in the event of various complications that may occur during TLE procedures.
KW - Aged
KW - Defibrillators, Implantable
KW - Device Removal/adverse effects
KW - Female
KW - Femoral Vein
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Pacemaker, Artificial
KW - Postoperative Complications/prevention & control
KW - Retrospective Studies
KW - Risk Factors
KW - Treatment Outcome
U2 - 10.1016/j.hrthm.2021.02.004
DO - 10.1016/j.hrthm.2021.02.004
M3 - SCORING: Journal article
C2 - 33577972
VL - 18
SP - 970
EP - 976
JO - HEART RHYTHM
JF - HEART RHYTHM
SN - 1547-5271
IS - 6
ER -
