From the Guidelines
Percutaneous lead extraction is the preferred method for removal of pacemaker leads in a clinic in New York City, as it can be accomplished relatively safely with a high rate of success in high-volume centers with experienced personnel and appropriate facilities 1. When considering pacemaker lead extraction, it is crucial to choose a high-volume center with a team experienced in handling potential complications, such as the Cardiac Electrophysiology Program at NewYork-Presbyterian/Columbia University Irving Medical Center. Some key points to consider when evaluating a facility for lead extraction include:
- The presence of experienced electrophysiologists and cardiac surgeons
- The use of state-of-the-art equipment, including laser extraction tools
- A comprehensive evaluation process, including detailed imaging of the leads and surrounding structures
- The ability to handle potential complications, such as cardiac tamponade, hemothorax, and pulmonary embolism According to a recent study, barriers to lead extraction include referral barriers, patient factors, and lack of optimal communication and coordination 1. Some key factors that may limit a patient from being considered for lead extraction include:
- High risk of procedural mortality
- Perceived difficulty or complexity of the procedure
- Patient comorbidities
- Age of the patient
- Age of the lead It is essential to consult with a cardiologist to determine the best option for a specific case, taking into account factors such as the patient's overall health, the reason for lead extraction, and the complexity of the case. In general, percutaneous lead extraction is a safe and effective procedure when performed in a high-volume center with experienced personnel, and it is the preferred method for removal of pacemaker leads 1.
From the Research
Pacemaker Lead Extraction Methods
The best method for pacemaker lead extraction in a clinic in New York City (NYC) can be determined by considering various studies on the topic.
- Transvenous pacemaker or implantable cardioverter defibrillator (ICD) lead extraction via mechanical or excimer laser sheath is typically safe and effective 2.
- A hybrid lead extraction technique that combines laser extraction with minimally invasive right thoracotomy has been shown to be safe and effective for removing high-risk chronic pacemaker or ICD leads 2.
- The use of laser sheath extraction has been associated with a better complete extraction rate and a lower bleeding rate compared to other methods 3.
- The Evolution mechanical dilator sheath is a new lead extraction tool that has been shown to be safe and effective, with a high success rate and no complications reported in initial studies 4, 5.
Considerations for Lead Extraction
When considering lead extraction, several factors should be taken into account, including:
- The duration of lead implantation, with longer durations associated with higher complication rates 2, 3.
- The presence of large vegetations or thrombi, fractured leads, and prior failed extraction, which are risk factors for higher complication rates or incomplete or failed lead removal 2.
- The use of a varied choice of extraction tools, arterial line monitoring, transesophageal echocardiography, general anesthesia, and an experienced team can help to minimize complications and improve outcomes 3.
- The importance of performing lead extraction procedures in a cardiac surgery center with experienced operators and backup facilities to manage potential complications 5, 6.
Success Rates and Complications
The success rates and complications associated with different lead extraction methods vary, but overall, the procedures have been shown to be safe and effective.
- A study using the Evolution mechanical dilator sheath reported a success rate of 85.3% without using a snare, and a clinical success rate of 97.5% 5.
- Another study reported a complete extraction rate of 93% using laser extraction, with a low complication rate and no procedurally related deaths 3.
- A review of lead extraction techniques reported a success rate of about 98% for percutaneous lead extraction in an expert center 6.