Forces applied during transvenous implantable cardioverter defibrillator lead removal

Carsten Lennerz, Herribert Pavaci, Christian Grebmer, Gesa von Olshausen, Verena Semmler, Alessandra Buiatti, Tilko Reents, Sonia Ammar, Isabel Deisenhofer, Christof Kolb, Carsten Lennerz, Herribert Pavaci, Christian Grebmer, Gesa von Olshausen, Verena Semmler, Alessandra Buiatti, Tilko Reents, Sonia Ammar, Isabel Deisenhofer, Christof Kolb

Abstract

Methods: 17 physicians, experienced in transvenous lead removal, performed a lead extraction manoeuvre of an ICD lead on a torso phantom. They were advised to stop traction only when further traction would be considered as harmful to the patient or when--based on their experience--a change in the extraction strategy was indicated. Traction forces were recorded with a digital precision gauge.

Results: Median traction forces on the endocardium were 10.9 N (range from 3.0 N to 24.7 N and interquartile range from 7.9 to 15.3). Forces applied to the proximal end were estimated to be 10% higher than those measured at the tip of the lead due to a friction loss.

Conclusion: A traction force of around 11 N is typically exerted during standard transvenous extraction of ICD leads. A traction threshold for a safe procedure derived from a pool of experienced extractionists may be helpful for the development of required adequate simulator trainings.

Figures

Figure 1
Figure 1
Torso phantom for simulation of a transvenous lead extraction procedure; white dashed line illustrates the course of the lead within the thorax. ∗Digital force gauge.
Figure 2
Figure 2
Traction force on the endocardium under a simulated extraction procedure.
Figure 3
Figure 3
Typical extraction pattern with a moderate increase of traction up to the maximum, followed by a complete release and a new extraction attempt; the maximum force [N] and force increase [N/s] for each of the extraction attempts are constant and reproducible in this highly experienced extractionist.
Figure 4
Figure 4
Traction increase [N/s] at the lead tip during simulated extraction procedure. One extreme value (22.4 N/s) represents a statistical outlier and was not included in the graph.

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Source: PubMed

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