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- Title
Elektrody ucięte lub spontanicznie zerwane migrujące do serca lub układu naczyniowego. Rzadkie zjawisko w analizie 3847 zabiegów przezżylnego usuwania elektrod.
- Authors
Kutarski, Andrzej; Jacheć, Wojciech; Pietura, Radosław; Stefańczyk, Paweł; Czajkowski, Marek; Sawonik, Sebastian; Tułecki, Łukasz; Nowosielecka, Dorota
- Abstract
BACKGROUND The problem of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been described in detail so far. The aim of the study was to describe migration of the cut proximal lead end (MPLE) to the cardiovascular system, its risks factors, management and outcomes of transvenous lead extraction (TLE). METHODS Retrospective analysis of 3847 consecutive extractions. RESULTS Initially, migrant leads made up 2.5%, later 0.5% of all extractions. Most MPLEs were ventricular (56.94%) and their proximal ends were in the venous system (68.06%). Most of them were pacing (95.83%) and passive fixation (98.61%) leads with the mean dwell time 148.0 months. Patients with MPLEs had longer implant duration, more abandoned leads, redundant lead loops, more leads and more procedures before extraction. Independent risk factors for MPLE were abandoned leads (OR = 8.473; P <0.001) and leads on both sides of the chest (2.981; P = 0.045). Higher NYHA class lowered the probability of MPLE (OR = 0.380; P <0.001). Procedure complexity was higher in the MPLE group (procedure duration, unexpected procedure difficulties, use of additional / advanced tools and alternative venous approach). There were no more major complications in the MPLE group but the rate of procedural success was lower because of more frequent retention of non-removable lead fragments. Extraction of MPLEs did not influence long-term survival. CONCLUSIONS 1. Extraction of migrant leads with their cut proximal ends in the CVS is rare in patients undergoing TLE (1.87%). 2. Risk factors include abandoned leads and leads on both sides of the chest; higher NYHA class lowered the probability of MPLE. 3. Extraction complexity in patients with MPLEs is higher as regards procedure duration, unexpected procedure difficulties, use of advanced tools and techniques but rates of major complications are comparable. 4. Extraction of MPLEs did not influence long-term survival.
- Subjects
POLAND; RISK assessment; COMPLICATIONS of prosthesis; MEDICAL device removal; TREATMENT effectiveness; CONFERENCES &; conventions; FOREIGN body migration; IMPLANTABLE cardioverter-defibrillators; CARDIOVASCULAR system; DISEASE risk factors
- Publication
Polish Heart Journal / Kardiologia Polska, 2024, Vol 82, p34
- ISSN
0022-9032
- Publication type
Article