Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC)

Melanie Maytin, Charles Henrikson, Ray H M Schaerf, Laurence M. Epstein, Roy M. John

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC. Methods We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high-volume centers. Patient and lead characteristics, indications, outcomes, and extraction sheath (ES) use were analyzed. Results Between 1999 and 2012, more than 2,000 lead extractions were performed at the three centers. Of these, 11 patients underwent 14 extractions meeting inclusion criteria. Mean implant duration was 74.5 months (range 6-140). In 11 patients, a total of 22 leads (16 high-voltage and six pace-sense leads) were extracted in 14 procedures. The cohort was 50% male with a mean age of 45 years (range, 25-56) and mean ejection fraction 55 ± 13%. The majority (64%) of leads were extracted due to lead malfunction, three patients had an ICD lead removed for exit block, and three patients underwent TLE for infectious complications (two local, one systemic). ES assistance with laser or mechanical cutting sheaths was employed in the vast majority of cases (85.7%). All leads were removed completely. There were no major procedural complications. In five cases, lead reimplantation encountered low-amplitude R waves requiring multiple attempted lead positions before final successful implant. Conclusions This is the first reported series of TLE in ARVC patients. TLE can be performed safely and effectively in patients with ARVC by experienced operators at high-volume centers with a low complication rate.

    Original languageEnglish (US)
    Pages (from-to)1280-1283
    Number of pages4
    JournalPACE - Pacing and Clinical Electrophysiology
    Volume36
    Issue number10
    DOIs
    StatePublished - 2013

    Fingerprint

    Arrhythmogenic Right Ventricular Dysplasia
    Implantable Defibrillators
    Lead
    Replantation
    Lasers
    Retrospective Studies
    Safety

    Keywords

    • ARVC
    • ICD
    • lead extraction
    • lead management

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC). / Maytin, Melanie; Henrikson, Charles; Schaerf, Ray H M; Epstein, Laurence M.; John, Roy M.

    In: PACE - Pacing and Clinical Electrophysiology, Vol. 36, No. 10, 2013, p. 1280-1283.

    Research output: Contribution to journalArticle

    Maytin, Melanie ; Henrikson, Charles ; Schaerf, Ray H M ; Epstein, Laurence M. ; John, Roy M. / Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC). In: PACE - Pacing and Clinical Electrophysiology. 2013 ; Vol. 36, No. 10. pp. 1280-1283.
    @article{8a8500a9e963464b83a76f340d166323,
    title = "Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC)",
    abstract = "Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC. Methods We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high-volume centers. Patient and lead characteristics, indications, outcomes, and extraction sheath (ES) use were analyzed. Results Between 1999 and 2012, more than 2,000 lead extractions were performed at the three centers. Of these, 11 patients underwent 14 extractions meeting inclusion criteria. Mean implant duration was 74.5 months (range 6-140). In 11 patients, a total of 22 leads (16 high-voltage and six pace-sense leads) were extracted in 14 procedures. The cohort was 50{\%} male with a mean age of 45 years (range, 25-56) and mean ejection fraction 55 ± 13{\%}. The majority (64{\%}) of leads were extracted due to lead malfunction, three patients had an ICD lead removed for exit block, and three patients underwent TLE for infectious complications (two local, one systemic). ES assistance with laser or mechanical cutting sheaths was employed in the vast majority of cases (85.7{\%}). All leads were removed completely. There were no major procedural complications. In five cases, lead reimplantation encountered low-amplitude R waves requiring multiple attempted lead positions before final successful implant. Conclusions This is the first reported series of TLE in ARVC patients. TLE can be performed safely and effectively in patients with ARVC by experienced operators at high-volume centers with a low complication rate.",
    keywords = "ARVC, ICD, lead extraction, lead management",
    author = "Melanie Maytin and Charles Henrikson and Schaerf, {Ray H M} and Epstein, {Laurence M.} and John, {Roy M.}",
    year = "2013",
    doi = "10.1111/pace.12197",
    language = "English (US)",
    volume = "36",
    pages = "1280--1283",
    journal = "PACE - Pacing and Clinical Electrophysiology",
    issn = "0147-8389",
    publisher = "Wiley-Blackwell",
    number = "10",

    }

    TY - JOUR

    T1 - Multicenter experience with transvenous lead extraction in arrhythmogenic right ventricular cardiomyopathy (ARVC)

    AU - Maytin, Melanie

    AU - Henrikson, Charles

    AU - Schaerf, Ray H M

    AU - Epstein, Laurence M.

    AU - John, Roy M.

    PY - 2013

    Y1 - 2013

    N2 - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC. Methods We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high-volume centers. Patient and lead characteristics, indications, outcomes, and extraction sheath (ES) use were analyzed. Results Between 1999 and 2012, more than 2,000 lead extractions were performed at the three centers. Of these, 11 patients underwent 14 extractions meeting inclusion criteria. Mean implant duration was 74.5 months (range 6-140). In 11 patients, a total of 22 leads (16 high-voltage and six pace-sense leads) were extracted in 14 procedures. The cohort was 50% male with a mean age of 45 years (range, 25-56) and mean ejection fraction 55 ± 13%. The majority (64%) of leads were extracted due to lead malfunction, three patients had an ICD lead removed for exit block, and three patients underwent TLE for infectious complications (two local, one systemic). ES assistance with laser or mechanical cutting sheaths was employed in the vast majority of cases (85.7%). All leads were removed completely. There were no major procedural complications. In five cases, lead reimplantation encountered low-amplitude R waves requiring multiple attempted lead positions before final successful implant. Conclusions This is the first reported series of TLE in ARVC patients. TLE can be performed safely and effectively in patients with ARVC by experienced operators at high-volume centers with a low complication rate.

    AB - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is becoming a more commonly diagnosed entity with frequent need for coincident implantable cardioverter defibrillator (ICD) therapy. Given predominant right ventricular disease with thinning of the wall, there is concern regarding the safety of transvenous lead extraction (TLE) in ARVC. Methods We performed a retrospective study of consecutive patients with ARVC undergoing TLE of ICD leads at three high-volume centers. Patient and lead characteristics, indications, outcomes, and extraction sheath (ES) use were analyzed. Results Between 1999 and 2012, more than 2,000 lead extractions were performed at the three centers. Of these, 11 patients underwent 14 extractions meeting inclusion criteria. Mean implant duration was 74.5 months (range 6-140). In 11 patients, a total of 22 leads (16 high-voltage and six pace-sense leads) were extracted in 14 procedures. The cohort was 50% male with a mean age of 45 years (range, 25-56) and mean ejection fraction 55 ± 13%. The majority (64%) of leads were extracted due to lead malfunction, three patients had an ICD lead removed for exit block, and three patients underwent TLE for infectious complications (two local, one systemic). ES assistance with laser or mechanical cutting sheaths was employed in the vast majority of cases (85.7%). All leads were removed completely. There were no major procedural complications. In five cases, lead reimplantation encountered low-amplitude R waves requiring multiple attempted lead positions before final successful implant. Conclusions This is the first reported series of TLE in ARVC patients. TLE can be performed safely and effectively in patients with ARVC by experienced operators at high-volume centers with a low complication rate.

    KW - ARVC

    KW - ICD

    KW - lead extraction

    KW - lead management

    UR - http://www.scopus.com/inward/record.url?scp=84886445483&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84886445483&partnerID=8YFLogxK

    U2 - 10.1111/pace.12197

    DO - 10.1111/pace.12197

    M3 - Article

    VL - 36

    SP - 1280

    EP - 1283

    JO - PACE - Pacing and Clinical Electrophysiology

    JF - PACE - Pacing and Clinical Electrophysiology

    SN - 0147-8389

    IS - 10

    ER -