TY - JOUR
T1 - Impact of fixation mechanism and helix retraction status on right ventricular lead extraction
AU - Frazer, Marissa
AU - Phan, Francis
AU - Przybylowicz, Ryle
AU - Krebsbach, Angela
AU - Dornblaser, John
AU - Jessel, Peter M.
AU - Bhamidipati, Castigliano
AU - Tibayan, Frederick A.
AU - Henrikson, Charles A.
N1 - Publisher Copyright:
© 2023 Heart Rhythm Society
PY - 2023/12
Y1 - 2023/12
N2 - Background: The impact of lead fixation mechanism on extractability is poorly characterized. Objective: We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads. Methods: A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0–9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups. Results: Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%. Conclusion: TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.
AB - Background: The impact of lead fixation mechanism on extractability is poorly characterized. Objective: We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads. Methods: A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0–9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups. Results: Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%. Conclusion: TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.
KW - Active fixation lead
KW - Fixation mechanism
KW - Helix retraction
KW - Passive fixation lead
KW - Technical difficulty
KW - Transvenous lead extraction
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U2 - 10.1016/j.hroo.2023.11.007
DO - 10.1016/j.hroo.2023.11.007
M3 - Article
AN - SCOPUS:85178575058
SN - 2666-5018
VL - 4
SP - 757
EP - 764
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 12
ER -