Lead Extraction

Author: Dawn S. Hui, MD
Institution: UT Health San Antonio
Date Reviewed: 2023
Learning Domain: Adult Cardiac Surgery
Learning Objective: Diagnosis and treatment of patients with hypertrophic cardiomyopathy
PowerPoint File: Lead Extraction

 

Discussion Points: Laser Lead Extraction

  • Indications
  • Risk Factors
  • Planning and Resources – Best Practices and     Expert Consensus 
  • Recognizing Location of Injury
  • Stabilizing the Patient
  • Surgical Repair

 

Discussion Points: Surgical Repair

  • Innominate vein injury
  • Right atrial injury
  • Right ventricular injury
  • SVC injury
     
  • Decide on cardiopulmonary bypass vs sucker bypass vs no bypass
  • Prevention of air entrainment – umbilical tape around IVC; clamping of SVC if high injury

 

References

  • Perez AA, Woo FW, Tsang DC, Carrillo RG. Transvenous Lead Extractions: Current Approaches and Future Trends. Arrhythm Electrophysiol Rev. 2018 Aug;7(3):210-217
  • Bashir J, Fedoruk LM, Ofiesh J, Karim SS, Tyers GF. Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction. Circ Arrhythm Electrophysiol. 2016 Sep;9(9):e003741. 
  • Wilkoff BL, Love CJ, Byrd CL, et al; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm. 2009 Jul;6(7):1085-104. 
  • Fermin L, Gebhard RE, Azarrafiy R, Carrillo R. Pearls of Wisdom for High-Risk Laser Lead Extractions: A Focused Review. Anesth Analg. 2018 Feb;126(2):406-412.
  • Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017 Dec;14(12):e503-e551. doi: 10.1016/j.hrthm.2017.09.001. Epub 2017 Sep 15. Erratum in: Heart Rhythm. 2021 Oct;18(10):1814. PMID: 28919379.
  • Azarrafiy R, Tsang DC, Boyle TA, Wilkoff BL, Carrillo RG. Compliant endovascular balloon reduces the lethality of superior vena cava tears during transvenous lead extractions. Heart Rhythm. 2017 Sep;14(9):1400-1404.