Extraction of nonfunctional endocardial leads in children
Introduction. Extraction of pacemaker and implantable cardioverter-defibrillator (ICD) leads in children is difficult clinical problem. Abandoned nonfunctional endocardial lead is an risk of venous obstruction or infection and makes new leads implantation more difficult. The purpose of this study was to sum up our experience in endocardial lead removing. Material and methods. From January 2007 do December 2008 we extracted 11 leads (9 pacemaker leads: 7 ventricular, 2 atrial and 2 ICD leads)from 11 children age from 5 to 17,2 (mean 13,1) years. The implant duration ranged from 0,9 to 11,4 (mean 4,9) years. The main reason for extraction was lead failure (7 leads), in free children with long permanent pacing pacemaker leads were dangerous tight because of the patients’ growth. In one case the lCD lead was removed because of sepsis. In all children the lead extraction procedure was performed under general anaesthesia by the same experienced team, the extracorporeal oxygenation and circulation system was available. In all children the Cook Medical system was used during the procedure. Results. Ten leads (90,9%) were completely removed. In one case a short fragment of pacing atrial lead strongly connected with ventricular lead was failure to extract. In this patient massive subclavian venous bleeding occurred as a main our complication. None required cardiac operation. Conclusion Extraction of en endocardial lead in children is possible even after long pacing duration, but experienced team and proper facilities are necessary. In children the main indication to remove is en endocardial lead failure.