Academic Journal
Feasibility and Outcomes of Intravenous Lithotripsy as an Adjunct in Complex Transvenous Lead Extraction.
| Τίτλος: | Feasibility and Outcomes of Intravenous Lithotripsy as an Adjunct in Complex Transvenous Lead Extraction. |
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| Συγγραφείς: | Mdaihly M; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Demian J; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Kochar AS; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Martin DO; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Nanjundappa A; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Younis A; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Dakik A; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Ismail J; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Motairek I; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Tabaja C; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Watfa A; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Santangeli P; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Hussein AA; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Wazni OM; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA., Callahan TD; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, Ohio, USA. |
| Πηγή: | Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2026 May; Vol. 37 (5), pp. 1021-1024. Date of Electronic Publication: 2026 Mar 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Blackwell Country of Publication: United States NLM ID: 9010756 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8167 (Electronic) Linking ISSN: 10453873 NLM ISO Abbreviation: J Cardiovasc Electrophysiol Subsets: MEDLINE |
| Imprint Name(s): | Publication: Malden, MA : Blackwell Original Publication: Mt. Kisco, N.Y. : Futura Pub., c1990- |
| Ιατρικοί όροι (MeSH): | Device Lead Extraction*/adverse effects , Device Lead Extraction*/methods , Lithotripsy*/adverse effects , Lithotripsy*/methods , Device Removal*/adverse effects , Device Removal*/methods , Defibrillators, Implantable* , Pacemaker, Artificial*, Humans ; Female ; Feasibility Studies ; Treatment Outcome ; Male ; Aged ; Registries ; Time Factors ; Risk Factors ; Middle Aged ; Aged, 80 and over ; Retrospective Studies |
| Περίληψη: | Background: Transvenous lead extraction (TLE) of old leads is associated with increased procedural complexity and risk due to the development of calcified vascular adhesions. This may necessitate additional tools to free the leads. Shockwave intravenous lithotripsy (IVL), which employs acoustic pressure waves to fracture calcified lesions, has emerged as an adjunctive tool in this setting. However, data on its feasibility in TLE remains limited. Objective: To evaluate the feasibility of IVL as an adjunctive tool in complex TLE cases, focusing on the extraction tools utilized, fluoroscopy duration, success rates, and associated complications. Methods: From a prospectively maintained registry, we analyzed all patients undergoing IVL-assisted TLE at our institution. These patients were matched to controls without IVL using propensity scores derived from baseline and procedural characteristics, including age, sex, infection indication, age of the oldest explanted lead, number of extracted leads, and number of extracted ICD leads. A matching ratio of 1:3 was applied to increase statistical power while maintaining covariate balance. Results: A total of 27 IVL-assisted cases were matched to 81 controls. Baseline demographics and comorbidities were well balanced between groups. The mean number of extracted leads and mean age of the oldest extracted lead were comparable (2.44 ± 0.98 vs. 2.49 ± 0.90, p = 0.81; 15.35 ± 5.80 vs. 15.78 ± 8.24 years, p = 0.80). IVL patients demonstrated significantly higher utilization of laser sheaths, either alone (100% vs. 77.7%, p = 0.006) or combined with mechanical tools (44.4% vs. 18.5%, p = 0.008). Median fluoroscopy time was significantly longer in the IVL group (50.2 vs. 15.7 min, p < 0.001). Complete IVL application from the brachiocephalic vein to the superior vena cava was achieved in 20 patients, while 7 were limited by proximal venous stenosis. Procedural and clinical success rates, as well as major and minor complications, were not significantly different between groups. Conclusion: We report the largest series on the use of shockwave IVL during complex TLE cases, with significantly higher fluoroscopy and procedure durations. Despite favorable safety and efficacy outcomes, adjunctive IVL did not confer clear clinical benefit, and the complexity of lead removal remained evident. (© 2026 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.) |
| References: | JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 2):1585-1592. (PMID: 37278685) JACC Cardiovasc Interv. 2021 Jun 28;14(12):1275-1292. (PMID: 34167671) HeartRhythm Case Rep. 2024 Jul 03;10(9):681-684. (PMID: 39355821) JACC Case Rep. 2025 Jul 9;30(18):104021. (PMID: 40645728) JACC Clin Electrophysiol. 2016 Aug;2(4):498-505. (PMID: 29759872) Heart Rhythm. 2017 Dec;14(12):e503-e551. (PMID: 28919379) |
| Contributed Indexing: | Keywords: complications; intravascular lithotripsy (IVL); procedural success; transvenous lead extraction (TLE) |
| Entry Date(s): | Date Created: 20260324 Date Completed: 20260713 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13182191 |
| DOI: | 10.1111/jce.70325 |
| PMID: | 41873199 |
| Βάση Δεδομένων: | MEDLINE |
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