Navigation of lead extraction-is it possible? Impact of preprocedural electrocardiogram-triggered computed tomography on navigation of lead extraction
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Navigation of lead extraction-is it possible? Impact of preprocedural electrocardiogram-triggered computed tomography on navigation of lead extraction. / Vogler, Julia; Pecha, Simon; Azarrafiy, Ryan; Castro, Liesa; Deuschl, Florian; Spink, Clemens; Linder, Matthias; von Hehn, Ulrike; Willems, Stephan; Reichenspurner, Hermann; Gosau, Nils; Hakmi, Samer.
In: EUR J CARDIO-THORAC, Vol. 54, No. 4, 01.10.2018, p. 745-751.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Navigation of lead extraction-is it possible? Impact of preprocedural electrocardiogram-triggered computed tomography on navigation of lead extraction
AU - Vogler, Julia
AU - Pecha, Simon
AU - Azarrafiy, Ryan
AU - Castro, Liesa
AU - Deuschl, Florian
AU - Spink, Clemens
AU - Linder, Matthias
AU - von Hehn, Ulrike
AU - Willems, Stephan
AU - Reichenspurner, Hermann
AU - Gosau, Nils
AU - Hakmi, Samer
PY - 2018/10/1
Y1 - 2018/10/1
N2 - OBJECTIVES: As the number of transvenous lead extractions continues to increase, preprocedural protocols for this procedure must be assessed. The objective of this study was to determine whether an electrocardiogram (ECG)-triggered computed tomography (Et-CT) with three-dimensional (3D) reconstructions could aid lead extractors in choosing the optimal tools to improve procedural success and avoid complications.METHODS: In this study, 31 patients scheduled for transvenous lead extraction underwent a preprocedural Et-CT between January 2016 and May 2017. Both 3D-reconstructions and the two-dimensional files were reviewed for possible lead adhesions, calcifications, migrations or perforations.RESULTS: Mean age was 46.7 ± 14.0 years. Seventy-one percent of patients were men, and 29.0% had undergone prior cardiac surgery. Indications for extraction included infection (n = 18, 58.1%), lead dysfunction (n = 8, 25.8%), upgrade (n = 3, 9.7%), severe tricuspid regurgitation (n = 1, 3.2%) and superior vena cava occlusion (n = 1, 3.2%). Eighteen patients had an implantable cardioverter defibrillator (58.1%). Sixty-eight of 70 targeted leads were extracted with a mean of 2.2 leads per patient and an average lead age of 109.3 ± 58.7 months. Et-CT files supported transvenous lead extraction by revealing possible adhesions in 16 patients, 5 perforations and 2 venous occlusions. Lead extraction was performed using the excimer laser, mechanical tools and femoral snares. Complete procedural success was achieved in 93.5% (n = 29) of cases. Clinical success was 100%, and intraoperative mortality was 0%.CONCLUSIONS: A preprocedural Et-CT with 3D reconstructions can help to visualize lead alignment and identify abnormalities that may foreshadow procedural difficulties. A preprocedural Et-CT may therefore aid lead extractors in choosing the optimal extraction tool and strategy.
AB - OBJECTIVES: As the number of transvenous lead extractions continues to increase, preprocedural protocols for this procedure must be assessed. The objective of this study was to determine whether an electrocardiogram (ECG)-triggered computed tomography (Et-CT) with three-dimensional (3D) reconstructions could aid lead extractors in choosing the optimal tools to improve procedural success and avoid complications.METHODS: In this study, 31 patients scheduled for transvenous lead extraction underwent a preprocedural Et-CT between January 2016 and May 2017. Both 3D-reconstructions and the two-dimensional files were reviewed for possible lead adhesions, calcifications, migrations or perforations.RESULTS: Mean age was 46.7 ± 14.0 years. Seventy-one percent of patients were men, and 29.0% had undergone prior cardiac surgery. Indications for extraction included infection (n = 18, 58.1%), lead dysfunction (n = 8, 25.8%), upgrade (n = 3, 9.7%), severe tricuspid regurgitation (n = 1, 3.2%) and superior vena cava occlusion (n = 1, 3.2%). Eighteen patients had an implantable cardioverter defibrillator (58.1%). Sixty-eight of 70 targeted leads were extracted with a mean of 2.2 leads per patient and an average lead age of 109.3 ± 58.7 months. Et-CT files supported transvenous lead extraction by revealing possible adhesions in 16 patients, 5 perforations and 2 venous occlusions. Lead extraction was performed using the excimer laser, mechanical tools and femoral snares. Complete procedural success was achieved in 93.5% (n = 29) of cases. Clinical success was 100%, and intraoperative mortality was 0%.CONCLUSIONS: A preprocedural Et-CT with 3D reconstructions can help to visualize lead alignment and identify abnormalities that may foreshadow procedural difficulties. A preprocedural Et-CT may therefore aid lead extractors in choosing the optimal extraction tool and strategy.
KW - Journal Article
U2 - 10.1093/ejcts/ezy106
DO - 10.1093/ejcts/ezy106
M3 - SCORING: Journal article
C2 - 29617993
VL - 54
SP - 745
EP - 751
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 4
ER -