Journal Article

The Needle's Eye Snare as a primary tool for pacing lead extraction

Frank A. Bracke, Lukas Dekker and Berry M. van Gelder

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 15, issue 7, pages 1007-1012
Published in print July 2013 | ISSN: 1099-5129
Published online December 2012 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eus426
The Needle's Eye Snare as a primary tool for pacing lead extraction

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Aims

The femoral approach for lead extraction is typically used as a bailout procedure. We describe the results of a femoral approach with a Needle's Eye Snare and Femoral Workstation as a primary tool for extracting pacing leads.

Patients and methods and results

Four hundred and seventy-six pacing leads implanted for >6 months were extracted in 229 consecutive patients (178 male, age 70.4 ± 12.7 years). First, traction was performed with a standard stylet, and if unsuccessful this was followed by the femoral approach with a Needle's Eye Snare. Traction sufficed for 136 leads and a femoral approach was required in 340 leads, their respective implant times were 3.7 ± 2.9 and 9.2 ± 5.8 years. The Needle's Eye Snare failed or was only partial successful (leaving a lead remnant of <4 cm) in, respectively, 1.8 and 3.8% of all leads, 2.7 and 7.1% of 182 right ventricular, 0.7 and 0% of 144 atrial leads, and in none of 14 coronary sinus leads. All leads implanted for <10 years were removed with a clinical success. Two patients were successfully operated after pericardial tamponade. There were no procedure-related deaths.

Conclusion

Needle's Eye Snare lead extraction has a low complication rate. The technique should be considered as a primary tool for extraction of pacing leads, particularly atrial and coronary sinus pacing leads. The results for extracting ventricular leads might be improved if larger bore sheaths with a better cutting edge were available.

Keywords: Pacemaker lead; Lead extraction; Femoral approach; Needle's Eye Snare

Journal Article.  3588 words.  Illustrated.

Subjects: Cardiovascular Medicine

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