• Melanie Maytin, Roger G Carrillo, Pablo Baltodano, Raymond H M Schaerf, Maria G Bongiorni, Andrea Di Cori, Antonio Curnis, Joshua M Cooper, Charles Kennergren, and Laurence M Epstein.
• Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mmaytin@partners.org
• Pacing Clin Electrophysiol. 2012 Jun 1; 35 (6): 641-7.

Background/ObjectiveActive fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited.MethodsWe performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers. Patient and procedural characteristics, indications for extraction, use of extraction sheath (ES) assistance, and outcomes are reported.ResultsBetween January 2009 and February 2011, 12 patients underwent transvenous lead extraction (TLE) of Medtronic StarFix® lead (Medtronic Inc., Minneapolis, MN, USA). The cohort was 83% male with mean age 71 ± 14 years. Average implant duration was 14.2 ± 5.7 months (2.3-23.6). All leads but one were removed for infectious indications (67% systemic infection). At the time of explant, the fixation lobes were completely retracted in only one of the 12 cases and ES assistance was required for lead removal in all cases (58% laser, 25% cutting, 25% mechanical, and 25% femoral). The majority of cases required advancement of the sheath into the CS (75.0%) and often into a branch vessel (41.7%). One lead could not be removed transvenously and required surgical lead extraction. There were no major complications. Examination of the leads after extraction frequently revealed significant tissue growth into the fixation lobes.ConclusionsAlthough TLE of active fixation CS leads can be a safe procedure in select patients and experienced hands, powered sheaths and aggressive techniques are frequently required for successful removal despite relatively short implant durations. This raises significant concern regarding future TLE of active fixation CS leads with longer implant durations.©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

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