TLE procedures
Before the TLE procedures, all patients performed cardiac CT and
angiography to assess any extravascular or extracardiac lead
positioning, identify the sites of any venous occlusions or stenosis,
and assess the regions of lead mobility and adherence. All the
procedures were performed by experienced electrophysiologists under
conscious sedation or general anesthesia in the cardiac surgery
operating room with cardiovascular surgeon backup. A temporary pacing
wire was inserted from the femoral vein before the procedure. The
invasive arterial pressure and intracardiac or transesophageal
echocardiography monitoring were recorded and cardiopulmonary bypass
equipment was always on standby during the procedure.
All leads were extracted transvenously through a subclavian or femoral
approach using the following 4 techniques; (1) manual traction using
normal or locking stylets, (2) laser-assisted lead extraction using an
excimer laser sheath (3) a mechanical sheath extraction using a
non-powered polypropylene dilator sheath (Cook Medical, USA) or a
bidirectional rotational mechanical sheath (Evolution RL, Cook Medical,
USA), or (4) a snare-assisted lead extraction using various snare tools
such as Goose neck snare (Medtronic, Minneapolis, MN, USA), Needle’s eye
snare (Cook Medical, USA), and Lassos (Osypka, GmbH, Grentzig-Whylen,
Germany). 18 Following manual traction, a mechanical
sheath extraction and/or laser-assisted lead extraction was selected
based on whether there was a venous occlusion or stenosis, lead-lead or
lead-tissue adherence, or extensive calcification. Alternatively, among
those with severe adhesions in the subclavian, innominate, or superior
vena cava veins, a femoral approach using the snaring technique was
applied once the tip of the passive fixation lead became free. After the
removal of the entire system, an active-fixation pacing lead was
immediately implanted from the jugular vein and connected to an
externalized PM until the time of the re-implantation in PM dependent
patients.
Complete success was defined as the successful removal of all the
targeted leads and all lead material from the vascular space.1 Major complications were defined as outcomes that
were life threatening, resulting in significant or permanent disability,
procedure-related deaths, or required surgical intervention.1 Minor complications were defined as events related
to the procedure that required medical intervention or minor procedural
intervention. 1