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DOI: 10.1055/s-0037-1598882
Limitations in the Extraction of Active Fixation Coronary Sinus Leads
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Based on current ESC guideline criteria cardiac resynchronization therapy (CRT) is a suitable treatment option for 5–10% of all heart failure patients. However, coronary sinus (CS) lead implantation for CRT can be technically demanding and carries the risk of lead dislodgement which is why active fixation mechanisms have been developed. We compared the procedural success in the extraction of active and passive fixation CS leads.
Methods: We retrospectively identified 22 patients who underwent CS lead extraction between January 2009 and January 2014 at our institution. Procedural variables were compared between both groups by reviewing medical records and operative reports.
Results: The mean patient age was 67.2 ± 9.8 years with 90.9% being male. The indication for lead removal were infectious complications in all cases. Extraction attempts were performed in 6 active and 16 passive fixation CS leads. All active fixation leads were Medtronic Attain StarFix™, Model 4195 (Medtronic Inc., Minneapolis, MN, USA). Extraction techniques included simple mechanical traction and lead locking devices with or without the use of laser extraction sheaths. The mean time from the initial implantation to the attempt of lead extraction was 9.9 ± 11.7 months for active and 48.7 ± 33.6 months for passive fixation leads. Successful removal of active fixation leads was achieved in only 3 out of 6 cases (50%), as opposed to 16 out of 16 (100%) in patients with passive fixation CS leads (p = 0.013). No death or surgical complications occurred during the 30-day follow-up in either group.
Conclusion: In our experience extraction of the active fixation Medtronic Attain StarFix™ lead is associated with a higher procedural failure rate compared with passive fixation CS leads.