Intravascular extraction of permanent pacemaker leads.

PURPOSE: Cardiac leads that became infected, fail, or are otherwise problematic present difficulties in the management of patients. In this report, we assess our intravascular countertraction technique.

METHOD: Between February 1990 and January 2001, 13 leads were removed from 11 patients using the intravascular countertraction technique. The reasons for lead extraction were pacemaker infection and lead dysfunction.

RESULTS

In two of these patients, the ventricular leads could not be completely removed. The complete success rate was 85% and the overall success rate was 92%. There were no serious complications such as cardiac rupture, vein injury, or death, and there were no clinical signs of pulmonary embolism. In one of the patients whose ventricular leads could not be removed completely, the ventricular lead was stretched from its previous round shape, but tricuspid valve regurgitation did not occur during the 3-year follow-up period. In the other patient, the distal electrode was left in the subclavian vein. However, this residual distal electrode did not migrate, and there were no clinical signs of any recurrence of infection.

CONCLUSIONS

The present study suggests that to remove leads successfully, the largest locking stylet that can be easily passed to the lead's tip through the coil lumen should be chosen in order to avoid valve injury, which can sometimes occur when a ventricular lead's locking stylet is left in the coil lumen.