Transvenous lead extraction in conduction system pacing

Nadeev Wijesuriya; Mark K Elliott; Vishal Mehta; Jonathan M Behar; Steven Niederer; Bruce L Wilkoff; Christopher A Rinaldi

doi:10.3389/fphys.2022.993604

Transvenous lead extraction in conduction system pacing

Front Physiol. 2022 Aug 11:13:993604. doi: 10.3389/fphys.2022.993604. eCollection 2022.

Authors

Nadeev Wijesuriya^{1

2}, Mark K Elliott^{1

2}, Vishal Mehta^{1

2}, Jonathan M Behar^{1

2}, Steven Niederer¹, Bruce L Wilkoff^{3

4}, Christopher A Rinaldi^{1

2

5}

Affiliations

¹ School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
² Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
³ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.
⁴ Department of Cardiovascular Medicine, Deb Family Endowed Chair in Lead Management, Cleveland Clinic, Cleveland, OH, United States.
⁵ Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, United Kingdom.

Abstract

Conduction System Pacing (CSP) delivered by His Bundle Pacing (HBP) or Left Bundle Pacing (LBP) are exciting novel interventions in the field of Cardiac Resynchronization Therapy (CRT). As the evidence base for CSP grows, the volume of implants worldwide is projected to rise significantly in the coming years. As such, physicians will be confronted with increasingly prevalent and vital issues arising in long-term follow up, including the management of infected, malfunctioning, or redundant CSP leads. Transvenous lead extraction (TLE) is the first-line option for removal of pacing leads when indicated in these circumstances. The evidence base for TLE in the context of CSP is still in its infancy. In this article, we first provide a brief overview of TLE. We then examine the data on the long-term performance of HBP leads. Next, we describe the features of the Medtronic Select Secure 3,830 lead, and how experience of TLE of this lead in the paediatric population has informed our practice. Finally, we review the current evidence for TLE in HBP and LBP, and discuss how future studies can address gaps in our current knowledge.

Keywords: CRT; conduction system pacing; his bundle pacing; left bundle area pacing; transvenous lead extraction.

Publication types

Review