--- abstract: | Recently introduced pacemaker leads float freely within the veins and myocardium. Later on, fibrous encapsulation of the lead develops 1. These adhesions not only occur at the lead tip but are commonly found anywhere along the whole length of the lead at sites where the lead is in contact with the vein or the myocardium 1,2,3,4. These adhesions hamper lead removal as tight scar tissue can withhold the leads during traction. This not only occurs at the level of the flings and tines of passive fixation leads but at any level of the lead body, especially at sites of unequal diameter for example electrodes and defibrillator coils. Further the lead tip is often larger than the lead body due to the fixation mechanism and adhering scar tissue and can become impacted on withdrawal in the narrow canal provided by the fibrous envelope. Force applied to leads is limited by the tensile strength of the insulation and conductor coils of the leads. They may severe with forceful traction, and denuded indwelling lead fragments have a higher incidence of thrombo-fibrotic complications and may maintain infection 5,6,7,8. Force is also limited by the impact of traction on the veins and myocardium. Unopposed traction can lead to invagination of the myocardium, myocardial rupture, arrhythmia, hypotension or avulsion of a tricuspid valve leaflet 9,10,11,12,13. Therefore, additional tools have been developed to assist in freeing the lead body from the adhesions as well as the lead tip from the myocardium, to prevent laceration of the myocardium and to provide enough room for the lead to be withdrawn whilst preventing disintegration of the lead. We describe the technical aspects of current endovascular techniques, the results, the complications and shortly discuss the indications. altloc: - http://www.ipej.org/0303/bracke.htm chapter: ~ commentary: ~ commref: ~ confdates: ~ conference: ~ confloc: ~ contact_email: ~ creators_id: [] creators_name: - family: Bracke given: FA honourific: '' lineage: '' date: 2003-07 date_type: published datestamp: 2005-04-20 department: ~ dir: disk0/00/00/42/58 edit_lock_since: ~ edit_lock_until: ~ edit_lock_user: ~ editors_id: [] editors_name: - family: Singh given: Balbir honourific: '' lineage: '' - family: Lokhandwala given: Yash honourific: '' lineage: '' - family: Francis given: Johnson honourific: '' lineage: '' - family: Gupta given: Anup honourific: '' lineage: '' eprint_status: archive eprintid: 4258 fileinfo: /style/images/fileicons/text_html.png;/4258/1/bracke.htm full_text_status: public importid: ~ institution: ~ isbn: ~ ispublished: pub issn: ~ item_issues_comment: [] item_issues_count: 0 item_issues_description: [] item_issues_id: [] item_issues_reported_by: [] item_issues_resolved_by: [] item_issues_status: [] item_issues_timestamp: [] item_issues_type: [] keywords: lead extraction; pacemaker; ICD lastmod: 2011-03-11 08:55:58 latitude: ~ longitude: ~ metadata_visibility: show note: ~ number: 3 pagerange: 101-108 pubdom: TRUE publication: Indian Pacing and Electrophysiology Journal publisher: Indian Pacing and Electrophysiology Group refereed: TRUE referencetext: |- 1. Lagergren, H, Dahlgren, S, and Norderstam, H. Cardiovascular tissue response to intracardiac pacemaking. Acta Chir Scand 132, 696-704. 1966. 2. Robboy SJ, Harthorne JW, Leinbach RC, Sanders CA, Austen WG: Autopsy findings with permanent pervenous pacemakers. Circulation 1969;39:495-501. 3. Becker AE, Becker MJ, Claudon DG, Edwards JE: Surface thrombosis and fibrous encapsulation of intravenous pacemaker catheter electrode. Circulation 1972;46:409-412. 4. Spittell PC, Hayes DL: Venous complications after insertion of a transvenous pacemaker. Mayo Clin.Proc. 1992;67:258-265. 5. Lewis AB, Hayes DL, Holmes DRJ, Vlietstra RE, Pluth JR, Osborn MJ: Update on infections involving permanent pacemakers. Characterization and management. J Thorac Cardiovasc Surg 1985;89:758-763. 6. Molina JE: Undertreatment and overtreatment of patients with infected antiarrhythmic implantable devices [see comments]. Ann.Thorac.Surg. 1997;63:504-509. 7. Mazzetti H, Dussaut A, Tentori C, Dussaut E, Lazzari JO: Superior vena cava occlusion and/or syndrome related to pacemaker leads. Am.Heart J. 1993;125:831-837. 8. Mitrovic V, Thormann J, Schlepper M, Neuss H: Thrombotic complications with pacemakers. Int.J.Cardiol. 1983;2:363-374. 9. Hubbell DS, Tyler GRJ, Zoble RG: Polyurethane sheath disintegration causing impaction of pacer lead and shock during attempted removal. Pacing.Clin.Electrophysiol. 1986;9:527-530 10. Furman S, Behrens M, Andrews C, Klementowicz P: Retained pacemaker leads. J Thorac Cardiovasc Surg 1987;94:770-772. 11. Jarvinen A, Harjula A, Verkkala K: Intrathoracic surgery for retained endocardial electrodes. Thorac.Cardiovasc.Surg. 1986;34:94-97. 12. Frandsen F, Oxhoj H, Nielsen B: Entrapment of a tined pacemaker electrode in the tricuspid valve. A case report. Pacing.Clin.Electrophysiol. 1990;13:1082-1083. 13. Lee ME, Chaux A, Matloff JM: Avulsion of a tricuspid valve leaflet during traction on an infected, entrapped endocardial pacemaker electrode. The role of electrode design. J.Thorac.Cardiovasc.Surg. 1977;74:433-435. 14. Rosenheck S, Weiss A, Leibowitz D, Sharon Z: Noninstrumental pacemaker and defibrillator lead removal. The importance of the rotation forces. Pacing Clin Electrophysiol 2002;25:1029-1036. 15. Bilgutay AM, Jensen NK, Schmidt WR, Garamella JJ, Lynch MF: Incarceration of transvenous pacemaker electrode. Removal by traction. Am.Heart J. 1969;77:377-379. 16. Imparato AM, Kim GE: Electrode complications in patients with permanent cardiac pacemakers. Ten years' experience. Arch.Surg. 1972;105:705-710. 17. Schmidt G, Wirtzfeld A, Himmler FC, Klein G, Alt E, Seidl KF, Prauer HW: [Removal of infected entrapped pacemaker electrodes by continuous traction (author's transl)] Dauerzugbehandlung infizierter inkarzerierter Schrittmacherelektroden. Dtsch.Med.Wochenschr. 1980;105:1609-1614. 18. Brodell GK, Castle LW, Maloney JD, Wilkoff BL: Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system. Am.J.Cardiol. 1990;66:964-966. 19. Goode LB, Byrd CL, Wilkoff BL, Clarke JM, Fontaine JM, Fearnot NE, Smith HJ, Shipko FJ: Development of a new technique for explantation of chronic transvenous pacemaker leads: five initial case studies. Biomed.Instrum.Technol. 1991;25:50-53. 20. Smith HJ, Fearnot NE, Byrd CL, Wilkoff BL, Love CJ, Sellers TD: Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. Pacing.Clin.Electrophysiol. 1994;17:2016-2020. 21. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Turk KT, Reeves R, Young R, Crevey B, Kutalek SP, Freedman R, Friedman R, Trantham J, Watts M, Schutzman J, Oren J, Wilson J, Gold F, Fearnot NE, Van Zandt HJ: Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 1999;22:1348-1357. 22. Bracke FA, Meijer A, van Gelder B: Learning curve characteristics of pacing lead extraction with a laser sheath. Pacing Clin Electrophysiol 1998;21:2309-2313. 23. Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C: Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial [In Process Citation]. J.Am.Coll.Cardiol. 1999;33:1671-1676. 24. Kennergren C: First European experience using excimer laser for the extraction of permanent pacemaker leads. Pacing.Clin.Electrophysiol. 1998;21:268-270. 25. Reiser, C., Byrd, C. L., Wilkoff, B. L., Love, C. J., Hayes, D. L., Sellers, T. D., and Schaerf, R. Pacing lead extraction with the Excimer sheath trial: final report. Pacing.Clin.Electrophysiol. 22, 708. 1998. 26. Reiser C, Taylor KD, Lippincott RA: Large laser sheaths for pacing and defibrillator lead removal. Lasers.Surg.Med. 1998;22:42-45. 27. Manolis AS, Maounis TN, Chiladakis J, Vassilikos V, Melita-Manolis H, Cokkinos DV: Successful percutaneous extraction of pacemaker leads with a novel (VascoExtor) pacing lead removal system. Am.J.Cardiol. 1998;81:935-938. 28. Klug D, Jarwe M, Messaoudene SA, Kouakam C, Marquie C, Gay A, Lacroix D, Kacet S: Pacemaker lead extraction with the needle's eye snare for countertraction via a femoral approach. Pacing Clin Electrophysiol 2002;25:1023-1028. 29. Kennergren C: Excimer laser assisted extraction of permanent pacemaker and ICD leads: present experiences of a European multi centre study. Eur.J.Cardiothorac.Surg. 1999;15:856-860. 30. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C: Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol 2002;25:804-808. 31. Danshi Li, et al. Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation 2000;101:2631-38 32. Bracke F, Meijer A, van Gelder B: Extraction of pacemaker and implantable cardioverter defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools. Pacing Clin.Electrophysiol. 2002;25:1037-1040. 33. Bracke FA, Meijer A, van Gelder LM: Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001;85:254-259. 34.. Parry G, Goudevenos J, Jameson S, Adams PC, Gold RG: Complications associated with retained pacemaker leads. Pacing.Clin.Electrophysiol. 1991;14:1251-1257. 35. Alt E, Neuzner J, Binner L, Gohl K, Res JC, Knabe UH, Zehender M, Reinhardt J: Three-year experience with a stylet for lead extraction: a multicenter study. Pacing.Clin.Electrophysiol. 1996;19:18-25. relation_type: [] relation_uri: [] reportno: ~ rev_number: 8 series: ~ source: ~ status_changed: 2007-09-12 16:57:42 subjects: - ipej succeeds: ~ suggestions: ~ sword_depositor: ~ sword_slug: ~ thesistype: ~ title: "The Lead Extractor's Toolbox: A Review Of Current Endovascular Pacemaker And ICD Lead Extraction Techniques\n" type: journalp userid: 4424 volume: 3