Transvenous Lead Extraction Without Dedicated Surgical Back up in Low-Risk Patients.

IF 7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2026-10-22 DOI:10.1016/j.hrthm.2026.10.042

Wissam Mekary, Neal Bhatia, Faisal M Merchant, Mikhael F El-Chami

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引用次数: 0

Abstract

Background: Transvenous lead extraction (TLE) is associated with major complications that could require immediate surgical rescue. These procedures are performed in an EP lab or hybrid OR with the presence of a surgical team on standby. We have designed an institutional protocol that permits performance of TLE in low-risk situations, in an EP lab without dedicated surgical back-up.

Objectives: To investigate outcomes of TLE in low-risk patients METHODS: We retrospectively identified patients who underwent low-risk TLE at Emory Healthcare between 2010-23. Low-risk TLE were defined as an extraction of a pacing or ICD lead with a dwell time >= 1 and <= 5 years or a lead < 1 year that required extraction tools.

Results: Among 482 patients who met the criteria, the average lead age was 2.8 ± 1.2 years. The mean number of targeted leads per patient was 1.6±0.7. Extraction tools were required in 33.1% of cases. Major complications occurred in 0.83% of patients (n=4): 2 pericardial effusions requiring pericardiocentesis, 1 pneumothorax and 1 death from cardiogenic shock in an end stage heart failure patient. The patients with pericardial effusions and pneumothorax were part of a procedure that required lead revisions and the insertion of 1 or more new leads. No patients required surgical rescue.

Conclusion: This study suggests that, in selected "low-risk" patients, TLE can be performed safely in an experienced EP lab at centers with on-site cardiac surgery but without a dedicated surgical standby team, potentially reducing resource utilization in resource-limited healthcare environments.

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低危患者无专用手术辅助的经静脉铅提取。

背景：经静脉铅提取术（TLE）与主要并发症相关，可能需要立即手术抢救。这些手术在EP实验室或混合手术室进行，手术团队随时待命。我们设计了一个机构方案，允许在低风险情况下，在没有专门手术支持的EP实验室中进行TLE。目的：研究低危患者TLE的预后方法：回顾性分析2010-23年间在埃默里医疗中心接受低危TLE治疗的患者。低风险TLE定义为起搏或ICD导联拔出，停留时间>= 1。结果：符合标准的482例患者中，平均导联年龄为2.8±1.2岁。每位患者的平均靶导联数为1.6±0.7。33.1%的病例需要拔牙工具。0.83%的患者（n=4）出现主要并发症：2例心包积液需要心包穿刺，1例气胸，1例终末期心力衰竭患者心源性休克死亡。有心包积液和气胸的患者需要导联修正并插入1根或更多的新导联。没有病人需要手术抢救。结论：本研究表明，在选定的“低风险”患者中，TLE可以在有现场心脏手术中心的经验丰富的EP实验室中安全地进行，但没有专门的外科备用团队，这可能会减少资源有限的医疗环境中的资源利用率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.