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Original Articles: Cardiovascular

Explantation of Implantable Defibrillator Leads Using Open Heart Surgery or Percutaneous Techniques

^a Department of Thoracic and Cardiovascular Surgery, University Hospital, Muenster, Germany
^b Department of Cardiology and Angiology, University Hospital, Muenster, Germany

Accepted for publication March 19, 2007.

^_* Address correspondence to Dr Camboni, Klinik fuer Thorax-, Herz- und Gefaesschirurgie, Uniklinik Muenster, Albert-Schweitzer Strasse 33, Muenster, D-48129, Germany (Email: dcamboni{at}arcor.de).

Background: To remove failing or infected implantable cardioverter defibrillator leads, percutaneous techniques and open heart surgery are two common approaches. However, well-defined indications for either technique are not available. We summarize our experience with implantable cardioverter defibrillator system explantation using open heart surgery and percutaneous lead removal.

Methods: A total of 1,391 transvenously introduced implantable cardioverter defibrillator systems were implanted during the analyzed time interval from January 1995 to June 2005 in our institution. In 21 patients (1.5%), open heart surgery for implantable cardioverter defibrillator lead and generator explantation was applied (group A), and in 53 patients (3.8%), a percutaneous lead removal was possible (group B). The log-rank test was used to calculate differences in survival between both patient groups, and the Student’s t test was applied for differences in nonlethal complications.

Results: The 30-day, 6-month, 12-month, and 5-year survival rates were 91%, 91%, 81%, and 71%, respectively, for group A patients, and 100%, 100%, 94%, and 78%, respectively, for group B patients, which was not statistically different (p = 0.11). After open heart surgery, survival was comparable for cases with lead removal because of lead infection and those with lead malfunction (p = 0.28); however, patients with open heart surgery had a longer hospital stay (p = 0.03). Student’s t test revealed no statistical difference in nonlethal complications between both patient groups (p = 0.37).

Conclusions: As open heart surgery yielded similar results with regard to survival and complications, implantable cardioverter defibrillator lead removal using extracorporeal circulation may be well justified as a last therapeutic option, eg, in case of large bacterial vegetations.