Skip to main content

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

Publication ,  Journal Article
Lewis, RK; Pokorney, SD; Greenfield, RA; Hranitzky, PM; Hegland, DD; Schroder, JN; Lin, SS; Milano, C; Daubert, JP; Smith, PK; Hurwitz, LM ...
Published in: Pacing Clin Electrophysiol
October 2014

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.

Duke Scholars

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

October 2014

Volume

37

Issue

10

Start / End Page

1297 / 1305

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Preoperative Care
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Female
  • Feasibility Studies
  • Electrocardiography
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lewis, R. K., Pokorney, S. D., Greenfield, R. A., Hranitzky, P. M., Hegland, D. D., Schroder, J. N., … Piccini, J. P. (2014). Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction. Pacing Clin Electrophysiol, 37(10), 1297–1305. https://doi.org/10.1111/pace.12485
Lewis, Robert K., Sean D. Pokorney, Ruth Ann Greenfield, Patrick M. Hranitzky, Donald D. Hegland, Jacob N. Schroder, Shu S. Lin, et al. “Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction.Pacing Clin Electrophysiol 37, no. 10 (October 2014): 1297–1305. https://doi.org/10.1111/pace.12485.
Lewis RK, Pokorney SD, Greenfield RA, Hranitzky PM, Hegland DD, Schroder JN, et al. Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction. Pacing Clin Electrophysiol. 2014 Oct;37(10):1297–305.
Lewis, Robert K., et al. “Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction.Pacing Clin Electrophysiol, vol. 37, no. 10, Oct. 2014, pp. 1297–305. Pubmed, doi:10.1111/pace.12485.
Lewis RK, Pokorney SD, Greenfield RA, Hranitzky PM, Hegland DD, Schroder JN, Lin SS, Milano C, Daubert JP, Smith PK, Hurwitz LM, Piccini JP. Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction. Pacing Clin Electrophysiol. 2014 Oct;37(10):1297–1305.

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

October 2014

Volume

37

Issue

10

Start / End Page

1297 / 1305

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Preoperative Care
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Female
  • Feasibility Studies
  • Electrocardiography