TRANSVENOUS LEAD EXTRACTION IN YOUNG PATIENTS. SPECIFICITY AND DISPARATENESS
A. Kutarski (1), K. Bieganowska (2), A. Zabek (3), A. Polewczyk (4)
(1) Dept of Cardiology Medical University of Lublin, (2) Dept. of Cardiology Children's Memorial Health Institute Warsaw Poland, (3) Department of Electrocardiology, John Paul II Hospital, Krakow, Poland, (4) District Hospital, II Clinical Cardiology Department Kielce, Poland
Introduction: There is considerable controversy regarding safety of transvenous lead extraction (TLE) in young pts and children due to different anatomy, more strong connecting tissue scar and it earlier it calcification.
Objective: The comparison of safety and feasibility of TLE in young and adult pts.
Methods: Using standard mechanical systems we have extracted ingrown PM/ICD leads from 1060 adult pts (21-70y; 62,7±13,4y) and in 36 <20y (14,9±3,6y) within the last 7 years. We compared effectiveness, complications and technical problems during TLE procedures in mentioned two groups of pts.
Results: .
Impression: TLE in young pts in much effort consuming (much stronger connecting tissue scar, frequent calcification or mineralisation) and entails more experienced operator because lead break is relatively frequent and lead have to be extracted in parts. Rare occurrence of pocket infection may be explained by implantation procedure in operation room m but not in EPS lab.
Conclusions: 1. Infective indications are much less frequent in young than adult pts. 2. In spite of simpler systems in young pts., effectiveness of TLE remain slightly lower; break of non-extractable distal lead fragment or tip of lead occurs in one-fourth TLE. 3. Young-age do not influence on appearance of major & minor TLE complications.
| Patient / procedure
|
<21 y
|
21-80 y
|
P
|
| Sex (% of male patients) |
29 (80,6%) |
669 (63,1%) |
0,049 |
| Endocarditis |
3 (8,3%) |
189 (17,8%) |
0,2108 |
| Pocket infection |
0 (0,0%) |
259 (24,5%) |
0,00013 |
| Non-infective indications |
33 (91,7%) |
611 (57,7%) |
0,00013 |
| Leads extracted in one pt. (SD) |
1,32±1,2 |
1,70±0,81 |
0,0067 |
| Leads in the system (SD) |
1,36±0,49 |
1,81±0,66 |
0,000054 |
| ICD lead extraction |
5 (13,9%) |
305 (28,8%) |
0,0781 |
| Implant dwelling time (y) (SD) |
6,88±3,5 |
6,96±5,2 |
0,9322 |
| Major complications |
1 (2,8%) |
16 (1,5%) |
0,9362 |
| Minor complications |
1 (2,8%) |
20 (1,9%) |
0,8145 |
| Full radiological success |
27 (75,0%) |
1002 (94,6%) |
0,000003 |
| Partial radiological success |
8 (22,3%) |
46 (4,3%) |
0,000002 |
| Operating room stay-in time (minutes) (SD) |
112,8±28,3 |
111,44±47,7 |
0,8650 |
