Academic Journal
Retained Wire Lead Extraction Techniques in Patients With Venous Occlusion.
| Τίτλος: | Retained Wire Lead Extraction Techniques in Patients With Venous Occlusion. |
|---|---|
| Συγγραφείς: | van Niekerk CJ; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA., Cerantola M; Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada., Sugrue A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Mirwais M; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Hyman MC; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Frankel DS; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Supple G; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Marchlinski F; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Schaller RD; Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: robert.schaller@pennmedicine.upenn.edu. |
| Πηγή: | JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2026 Aug; Vol. 12 (8), pp. 1966-1976. Date of Electronic Publication: 2026 Apr 02. |
| Τύπος έκδοσης: | Journal Article; Research Support, Non-U.S. Gov't |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101656995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-5018 (Electronic) Linking ISSN: 2405500X NLM ISO Abbreviation: JACC Clin Electrophysiol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [New York, NY] : Elsevier Inc., [2015]- |
| Ιατρικοί όροι (MeSH): | Device Lead Extraction*/methods , Pacemaker, Artificial*/adverse effects , Defibrillators, Implantable*/adverse effects , Device Removal*/methods, Humans ; Retrospective Studies ; Female ; Male ; Aged ; Middle Aged |
| Περίληψη: | Background: Venous occlusion is a common consequence of chronic indwelling cardiovascular implantable electronic device (CIED) leads within the venous system, posing a significant barrier to lead revision or system upgrade. Traditional options for regaining access, such as transvenous lead extraction (TLE), epicardial systems, or contralateral tunneling, are associated with increased morbidity or technical complexity. Retained wire techniques, which leverage preexisting leads to traverse occlusions, represent a practical alternative, but data remain limited. Objectives: This study sought to evaluate the feasibility, safety, and outcomes of 4 retained wire techniques, each combined with venoplasty, for re-establishing venous access in patients with complete venous occlusion undergoing CIED revision or upgrade. Methods: This retrospective study included patients undergoing TLE for CIED revision or upgrade at a single center (2020 to 2025) with complete venous occlusion. Retained wire techniques included wire-under-insulation (above or below), wire-in-lumen, and wire-through-coronary sinus lead. Venoplasty was performed in most cases following successful wire placement. Results: Among 60 eligible patients, 50 (83%) had leads that were freely mobile and underwent a retained wire strategy. Access was successfully re-established in 49 of 50 cases (98%). Wire-in-lumen was most effective (35 of 36, 97%), whereas wire-under-insulation from above had limited success (3 of 9, 33%). Venoplasty was performed in 92% of cases. One pericardial effusion occurred requiring pericardiocentesis. Conclusions: Retained wire techniques offer a safe and effective solution for managing venous occlusion during CIED revision or upgrade, particularly when leads are mobile and dwell time is modest. The wire-in-lumen technique demonstrated the highest success and broadest applicability. (Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Funding Support and Author Disclosures This work was supported by the Mark Marchlinski EP Research and Education Fund. Dr Schaller serves on the Philips advisory board and has received speaking honoraria from Merit. The remaining authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
| Contributed Indexing: | Keywords: femoral traction; lead extraction; retained wire; snaring; venous occlusion |
| Entry Date(s): | Date Created: 20260403 Date Completed: 20260825 Latest Revision: 20260825 |
| Update Code: | 20260826 |
| DOI: | 10.1016/j.jacep.2026.02.025 |
| PMID: | 41931077 |
| Βάση Δεδομένων: | MEDLINE |
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