Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction.

Published

Journal Article

BACKGROUND: Preprocedural multidetector computed tomography (MDCT) may identify patients at risk for mechanical complications during lead extraction. METHODS: To describe the use and feasibility of computed tomography scanning for preprocedural planning of lead extraction, we conducted a retrospective study of high-risk patients, who underwent electrocardiogram (ECG)-gated MDCT before planned lead extraction between January 1, 2012, and March 30, 2013. RESULTS: Among 30 patients the mean age was 63 ± 15 years, 60% were male, and 20% had prior sternotomy. Most devices were left sided (93%) and 24 had implantable defibrillators (80%). Indications for extraction included lead malfunction (n = 15; 50%), class I lead advisories (n = 11; 37%), and infection (n = 10; 33%). Overall, there were 65 leads extracted (mean 2.1 leads per patient). One extraction procedure was deferred due to MDCT evidence of significant myocardial perforation with the lead tip > 1 cm beyond the epicardium (n = 1, 3%). MDCT suggestion of lead adherence to central venous structures (n = 13, 43%) was associated with significantly longer laser times (88 ± 71 seconds vs 30 ± 37 seconds, P = 0.02) and larger sheath size (14.9 ± 1.3 vs 13.5 ± 1.2 French, P = 0.02). MDCT evidence of central venous occlusion or stenosis was not associated with increased laser times. Excluding the patient with MDCT evidence of significant perforation, clinical success was achieved in all patients (n = 29/29). CONCLUSIONS: ECG-gated MDCT scanning before lead extraction may facilitate the identification of significant perforation and patients at high risk for mechanical complication.

Full Text

Duke Authors

Cited Authors

  • Lewis, RK; Pokorney, SD; Greenfield, RA; Hranitzky, PM; Hegland, DD; Schroder, JN; Lin, SS; Milano, C; Daubert, JP; Smith, PK; Hurwitz, LM; Piccini, JP

Published Date

  • October 2014

Published In

Volume / Issue

  • 37 / 10

Start / End Page

  • 1297 - 1305

PubMed ID

  • 25195955

Pubmed Central ID

  • 25195955

Electronic International Standard Serial Number (EISSN)

  • 1540-8159

Digital Object Identifier (DOI)

  • 10.1111/pace.12485

Language

  • eng

Conference Location

  • United States