Effectiveness and Feasibility of Powered Sheath Systems for Transvenous Lead Removals of Cardiac Rhythm Management Device

概要

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More than 40 years passed after induction of cardiac rhythm management device (CRMD). According to the increase in number of the patients with CRMD, powered sheath for lead extraction has been requesting because of failed or infected pacemaker or ICD leads. We evaluate the safety and efficacy of powered sheath systems (EDS, Electrosurgical dissection sheath, Cook, and Excimer laser sheath, Spectranetics) in transvenous lead extraction. Between 2005 and 2010, 104 lead extraction procedures were performed in 103 patients for removal of 203 leads. Mean 6.4 years (longest 24 years) passed after the lead implantation. Procedural indications were infection in 82%, non-functional lead in 17%, atrial lead perforation in 1 and SVC syndrome in 1 patient. Overall, 196 leads (96.6%) were completely and 7 leads (3.4%) were partially extracted. Indication diseases were improved in all patients with non-functional leads, all but two patients with infection and one patient with SVC syndrome. Acute complications occurred in 9 of 104 procedures (8.7%): 1 major (tamponade) and 8 minor (blood transfusion, pulmonary embolism). Powered sheath systems (EDS, Excimer Laser) are effective and feasible in transveous pacemaker or ICD lead removals.