Arq. Bras. Cardiol. 2021; 116(5): 917-918
Removal of Transvenous Pacing Leads in Artificial Cardiac Stimulation Systems
This Short Editorial is referred by the Research article "Percutaneous Removal of Cardiac Leads in a Single Center in South America".
The pacing leads are the most fragile part of the artificial cardiac stimulation systems, being responsible for the majority of complications. The removal of transvenous pacing leads has always been a challenge, and for a long time the percutaneous removal was reserved for the most recently implanted leads and thoracotomy was the best option for the older cases.
Since the 1990s, several tools for removing leads have been developed, such as: special stainless steel guide wires with locks (locking stylet), counter-traction sheaths without or with mechanical release mechanisms or laser-powered ones and long deflectable sheaths with snare guides for femoral extraction. These instruments allowed the percutaneous extraction of older leads with high success and low complication rates, as demonstrated in the European Electra Study, which involved 3,510 patients with 96.7% of clinical success and 1.7% of major complications. With the increase in indications and greater complexity of artificial cardiac stimulation (ACS) systems, which sometimes required up to 4 leads, in addition to the longer survival of the patients, which implies in several generator exchanges, the need for lead removal, sometimes mandatory, has considerably increased.
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