Lead Extraction in Children and Young Adults Using Different Techniques

Objective: To describe our experience with removal of pacing lead in children using different techniques. Patients and Methods: Between 1999 and 2006, removal of 39 leads was attempted in 30 patients: 21 males and 9 females aged 4-21 years (mean 12 +/- 5 years). Sixteen patients had previous corrective cardiac surgery. The leads had been implanted for 46 +/- 31 months (range 1-120 months). The reasons for removal included lead fracture in 14, upgrading in 8, infection in 7, dislodgment in 5, pacing system not needed in 2, and other reasons in 3. Results: Of the 39 leads, 29 (74.3%) were completely removed. Twelve leads were removed with simple traction and rotation and 9 were removed using a locking stylet combined with simple traction and rotation; a laser extraction system was used in 10 cases in which 8 leads were successfully removed. Duration of implantation was the only important predictor for successful removal. Three patients necessitated surgical lead removal and had epicardial pacemaker implantation. Conclusion: Using currently available techniques, percutaneous pacemaker lead removal was possible in the majority of cases, although a significant number of cases were not successful. Attempted lead removal with simple traction and rotation resulted in the need for surgical removal in a significant number of patients. Newer techniques should be developed to increase the success rate. Copyright (C) 2009 S. Karger AG, Basel