Korean Circ J.  2016 Mar;46(2):186-196. 10.4070/kcj.2016.46.2.186.

Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction

• Jo U
• Kim J
• Hwang YM
• Lee JH
• Kim MS
• Choi HO
• Lee WS
• Kwon CH
• Ko GY
• Yoon HK
• Nam GB
• Choi KJ
• Kim YH

• KMID: 2344470
• DOI: http://doi.org/10.4070/kcj.2016.46.2.186

Abstract

BACKGROUND AND OBJECTIVES
The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction.
SUBJECTS AND METHODS
The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups.
RESULTS
The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B.
CONCLUSION
Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.

Keyword

Pacemaker, artificial; Defibrillators, implantable; Device removal

MeSH Terms

Defibrillators
Defibrillators, Implantable
Device Removal
Humans
Pacemaker, Artificial
SNARE Proteins*
Traction*
SNARE Proteins

Figure

• 

  Fig. 1 Extraction of dual-chamber defibrillator leads. (A) The active fixation lead is removed by simple traction. (B) A closed loop is formed with the snare (white arrowhead) and ablation catheter (black arrowhead) capturing target ICD lead. (C) Downward traction of the snare and ablation catheter complex is performed gently. Repeated traction and release are required for complete removal. (D) The tip of the ICD lead is detached from the RV apex. The SVC coil is already moved into the subclavian vein with traction. (E) The entire ICD lead is removed by manual traction via the entry site. (F) Fluoroscopy shows absence of residual lead material. ICD: implantable cardioverter defibrillator, RV: right ventricle, SVC: superior vena cava.

• 

  Fig. 2 Extraction of dual-chamber pacemaker leads. (A) The tip of ablation catheter is bended to anchor the right atrial lead. (B) A closed loop capturing target lead is formed with the snare and ablation catheter. (C) The right atrial lead is detached from the insertion site by gentle traction. (D) Manual removal of the detached right atrial lead via the entry site is impossible, probably due to venous occlusion. (E) The tip of the right atrial lead is grasped by the snare. (F) The lead is cut at the entry site. The proximal fragment was removed via entry site, and the distal fragment was removed easily via the femoral vein without residual lead material.

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  Fig. 3 Right anterior oblique views of the leads that could not be extracted via the femoral approach. (A) A remnant pacing lead in the right ventricle after surgical extraction could not be extracted owing to failure to capture the remnant lead. (B) A remnant defibrillator lead that was fractured during traction from below could not be removed owing to failure to capture the remnant lead.

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