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A single-centre experience of over one thousand lead extractions.

Författare och institution:
Charles Kennergren (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); Christian Bjurman (Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning); Roger Wiklund (-); Jakob Gäbel (Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin)
Publicerad i:
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 11 ( 5 ) s. 612-7
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
AIMS: The aim of the study was to present a single-centre experience of pacemaker and implantable cardioverter defibrillator (ICD) lead extraction using different methods, mainly laser-assisted extraction. METHODS AND RESULTS: Data from 1032 leads and 647 procedures were gathered. A step-by-step approach using different techniques while performing an ongoing risk-benefit analysis was used. The most common indications were local infection, systemic infection, non-functional lead, elective lead replacement, and J-wire fracture. Mean implantation time for all leads was 69 months and for laser-extracted leads 91 months. Laser technique was used to extract 60% of the leads, 29% were manually extracted, 6% extracted with mechanical tools, 4% were surgically removed, and 0.6% extracted by a femoral approach. Failure rate was 0.7%, and major complication rate was 0.9%. No extraction-related mortality occurred. Median time for laser extraction was 2 min. Long implantation time was not a risk factor for failure or for complication. CONCLUSION: Pacing and ICD leads can safely, successfully, and effectively be extracted. Leads can often be extracted by a superior transvenous approach; however, open-chest and femoral extractions are still required. Laser-assisted lead extraction proved to be a useful technique to extract leads that could not be removed by manual traction. The results indicate that the paradigm of abandoning redundant leads, instead of removing them, may have to be reconsidered.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Adolescent, Adult, Aged, Aged, 80 and over, Child, Defibrillators, Implantable, Device Removal, adverse effects, methods, Endpoint Determination, Equipment Failure, Female, Foreign-Body Migration, Humans, Infection Control, Male, Middle Aged, Pacemaker, Artificial, Retrospective Studies, Risk Assessment, Young Adult
Postens nummer:
Posten skapad:
2010-01-14 13:06
Posten ändrad:
2010-01-26 12:48

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