Key result
Removal of active fixation coronary sinus leads resulted in a lower procedural success rate compared to passive fixation leads.
Why the study?
Does the removal of active fixation coronary sinus leads have a lower procedural success rate compared to passive fixation leads in patients with device infections?
Cohort (n=22)
No
Does the removal of active fixation coronary sinus leads have a lower procedural success rate compared to passive fixation leads in patients with device infections?
Removal of active fixation coronary sinus leads is associated with a significantly higher procedural failure rate compared to passive fixation leads, even with shorter implant durations.
Answers are grounded in this paper and cite their sources.
Active fixation CS lead removal may lower success; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Implantation of coronary sinus (CS) leads may be a difficult procedure due to different vein anatomies and a possible lead dislodgement. The mode of CS lead fixation has changed and developed in recent years. OBJECTIVES: We compared the removal procedures of active and passive fixation leads. METHODS: Between January 2009 and January 2014, 22 patients at our centre underwent CS lead removal, 6 active and 16 passive fixation leads were attempted using simple traction or lead locking devices with or without laser extraction sheaths. Data on procedural variables and success rates were collected and retrospectively analyzed. RESULTS: The mean patient age was 67.2 ± 9.8 years, and 90.9% were male. The indication for lead removal was infection in all cases. All active fixation leads were Medtronic® Attain StarFix™ Model 4195 (Medtronic Inc., Minneapolis, MN, USA). The mean time from implantation for the active and passive fixation leads was 9.9 ± 11.7 months (range 1.0-30.1) and 48.7 ± 33.6 months (range 5.7-106.4), respectively (p = 0.012). Only 3 of 6 StarFix leads were successfully removed (50%) compared to 16 of 16 (100%) of the passive fixation CS leads (p = 0.013). No death or complications occurred during the 30-day follow-up. CONCLUSION: According to our experience, removal of the Starfix active fixation CS leads had a higher procedural failure rate compared to passive.
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Pecha et al. (2016) conducted a cohort in Coronary sinus lead infection requiring removal (n=22). Active fixation coronary sinus leads vs. Passive fixation coronary sinus leads was evaluated on Procedural success rate of lead removal (p=0.013). Removal of active fixation coronary sinus leads resulted in a lower procedural success rate compared to passive fixation leads.
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