Active fixation mechanism complicates coronary sinus lead extraction and limits subsequent reimplantation targets
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Implantation of cardiac resynchronization therapy (CRT) devices is technically challenging and can be limited by lead dislodgement. The Attain Starfix active fixation coronary sinus (CS) lead (model 4195, Medtronic, Minneapolis, MN, USA) was introduced to reduce the rate of lead dislodgement, but the active fixation mechanism presents additional difficulties should these leads require extraction.
CS lead extraction procedures at our institution from 2003 to 2011 were reviewed. Procedural variables were compared between extraction of the Starfix lead and passive fixation CS leads. Attempts at reimplantation post Starfix lead extraction were examined.
Four Starfix CS leads were extracted in four patients during this time period. The mean implant duration was 784 days (range, 392–1,029 days). The indication for extraction was infection in all four cases. Mean total procedure time was 141.5 min (range, 92–205 min). None of the fixation lobes could be retracted in one lead and only the most proximal lobes could be retracted in the remaining three leads. All four leads were removed in their entirety. The excimer laser sheath (Spectranetics Laser Sheath II, Spectranetics Corp., Colorado Springs, CO,USA) was required to remove the lead in all 4 cases (100 %) compared to 25 of 131 (19.1 %) of passive fixation CS lead extractions (mean implant duration, 659 ± 697 days) performed at our institution over the same time period (P < 0.001). In three cases, the laser sheath had to be advanced past the CS ostium to remove the Starfix lead. After extraction, fibrous material which had grown between the lobes of the fixation mechanism was noted in all four cases. No complications occurred. Transvenous CS lead reimplantation was attempted at a median of 7.5 days post extraction in all four patients. The original target branch was occluded in three patients and the main CS in one patient. Reimplantation was successful in another branch of the CS in three of four patients; one underwent minimally invasive epicardial lead placement.
The Starfix active fixation CS lead presents additional procedural complexity and uniform use of excimer laser sheath compared to other CS leads. Reimplantation was not possible in the same venous branch in our experience.
- Epstein, A. E., DiMarco, J. P., Ellenbogen, K. A., et al. (2008). ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation, 117, e350–e408. CrossRef
- Jessup, M., Abraham, W. T., & Casey, D. E. (2009). 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in Collaboration with the International Society for Heart and Lung Transplantation. Circulation, 119, 1977–2016. CrossRef
- Linde, C., Abraham, W. T., Gold, M. R., St John Sutton, M., Ghio, S., & Daubert, C. (2008). Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. Journal of the American College of Cardiology, 52, 1834–1843. CrossRef
- Moss, A. J., Hall, W. J., Cannom, D. S., et al. (2009). Cardiac-resynchronization therapy for the prevention of heart-failure events. The New England Journal of Medicine, 361, 1329–1338. CrossRef
- Tang, A. S. L., Wells, G. A., Talajic, M., et al. (2010). Cardiac-resynchronization therapy for mild-to-moderate heart failure. The New England Journal of Medicine, 363, 2385–2395. CrossRef
- Leon, A. R., Abraham, W. T., Curtis, A. B., et al. (2005). Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2,000 patients from a multicenter study program. Journal of the American College of Cardiology, 46, 2348–2356. CrossRef
- Naegele, H., Azizi, M., Hashagen, S., Castel, M. A., & Behrens, S. (2007). First experience with a new active fixation coronary sinus lead. Europace, 9, 437–441. CrossRef
- Luedorff, G., Kranig, W., Grove, R., Wolff, E., Heimlich, G., & Thale, J. (2010). Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus lead. Europace, 12, 825–829. CrossRef
- Crossley, G. H., Exner, D., Mead, R. H., et al. (2010). Chronic performance of an active fixation coronary sinus lead. Heart Rhythm, 7, 472–478. CrossRef
- Medtronic Inc. CDRM Product Performance eSource. Retrieved March 18, 2012, from http://wwwp.medtronic.com/productperformance/model/4195-attain-starfix.html.
- Baranowski, B., Yerkey, M., Dresing, T., & Wilkoff, B. L. (2011). Fibrotic tissue growth into the extendable lobes of an active fixation coronary sinus lead can complicate extraction. Pacing and Clinical Electrophysiology, 34, e64–e65. CrossRef
- Rickard, J., & Wilkoff, B. L. (2011). Extraction of implantable cardiac electronic devices. Current Cardiology Reports, 13, 407–414. CrossRef
- Williams, S. E., Arujuna, A., Whitaker, J., et al. (2011). Percutaneous lead and system extraction in patients with cardiac resynchronization therapy (CRT) devices and coronary sinus leads. Pacing and Clinical Electrophysiology, 34, 1209–1216. CrossRef
- Bongiorni, M. G., Di Cori, A., Zucchelli, G., Segreti, L., De Lucia, R., Paperini, L., et al. (2011). A modified transvenous single mechanical dilatation technique to remove a chronically implanted active fixation coronary sinus pacing lead. Pacing and Clinical Electrophysiology, 34, e66–e69. CrossRef
- Breuls, N., & Res, J. C. (2008). LV lead fixation in a coronary vein may be the cause and result of thrombosis. Pacing and Clinical Electrophysiology, 31, 1506–1507. CrossRef
- Burke, M. C., Morton, J., Lin, A. C., et al. (2005). Implications and outcome of permanent coronary sinus lead extraction and reimplantation. Journal of Cardiovascular Electrophysiology, 16, 830–837. CrossRef
- Active fixation mechanism complicates coronary sinus lead extraction and limits subsequent reimplantation targets
Journal of Interventional Cardiac Electrophysiology
Volume 36, Issue 1 , pp 81-86
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Cardiac resynchronization therapy (CRT)
- Coronary sinus
- Lead extraction
- Active fixation lead
- Industry Sectors
- Author Affiliations
- 1. Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Desk J2-2, 9500 Euclid Avenue, Cleveland, OH, 44195, USA