Document Detail

Extraction of implanted transvenous pacing leads: a review of a persistent clinical problem.
MedLine Citation:
PMID:  2000756     Owner:  NLM     Status:  MEDLINE    
Within a few months of implantation, permanent pacemaker leads become ensheathed in fibrocollagenous tissue. This tissue may anchor the lead so that it is difficult, dangerous, or impossible to remove it. Leads with bulbous or finned tips are particularly resistant to extraction. The risks of applying traction to an entrapped lead include induction of bradycardia or ventricular tachycardia and fibrillation, invagination of the right ventricle, avulsion of the right ventricular myocardium or tricuspid valve, hemopericardium, and cardiac tamponade. Forceful traction may result in uncoiling of the conductor, disruption of the insulation, or complete fracture, leaving an intravascular remnant that may embolize or be a source for thrombosis. Although fixation and abandonment of an inactive chronically implanted lead is frequently appropriate and is known to pose little long-term risk, the retained inactive lead may interact adversely with a new active lead and then increase the risk of venous thrombosis, serve as a potential nidus for infection, or produce spurious electrical sensing signals that may be sensed by the pulse generator. Absolute indications for lead removal are those in which there would be a life-threatening situation if the lead were to remain in situ. In the absence of an absolute indication, the decision to proceed with extraction must be made by weighing the potential for serious morbidity or mortality against risks of the extraction technique. Techniques for lead removal include traction and open cardiotomy operations. When a portion of the lead is intravascular, forceps, snares, baskets, countertraction, or lead-transection devices may be used to retrieve the fragment.
M R Myers; V Parsonnet; A D Bernstein
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American heart journal     Volume:  121     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1991 Mar 
Date Detail:
Created Date:  1991-04-08     Completed Date:  1991-04-08     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  881-8     Citation Subset:  AIM; IM    
Division of Cardiac Electrophysiology, Huntington Hospital, Pasadena, CA 91105.
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MeSH Terms
Electrodes, Implanted*
Foreign Bodies / therapy*
Foreign-Body Migration / therapy*
Infection / etiology
Pacemaker, Artificial*
Surgical Instruments
Comment In:
Am Heart J. 1992 Dec;124(6):1667-8   [PMID:  1462947 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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