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Coronary Sinus Lead Extraction: Higher Complication Risk or Clinical Misconception?
Session:
Sessão de Comunicações Orais 03 – Intervenções avançadas na doença vascular pulmonar e em complicações de dispositivos
Speaker:
Raquel França Moreira
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Raquel França Moreira; Leonor Magalhães; Margarida Figueiredo; Guilherme Portugal; Paulo Osório; Sofia Jacinto; Madalena Cruz; Ana Lousinha (Phd); Pedro Silva Cunha (Phd); Rui Ferreira; Bruno Valente; Mário Oliveira (Phd)
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Cardiac device extraction has grown dramatically in recent years and is likely to continue expanding. Each case has its own technical challenges and specificities; however, coronary sinus lead extraction has always inspired particular respect and fear among physicians, due to the risk of adhesions that may lead to coronary venous tears and potentially life-threatening complications. This study aimed to compare lead extraction outcomes and procedural characteristics between Cardiac Resynchronization Therapy (CRT) and non-CRT devices in a tertiary center.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: A retrospective analysis was conducted on 282 consecutive lead extractions between 2013 and 2024 (60 CRT; 222 non-CRT). Clinical records were reviewed. Two groups were compared: CRT extractions and non<span style="font-family:"Cambria Math",serif">-</span>CRT extractions (without a coronary sinus lead). The statistical analysis comprised chi-square tests and comparisons of proportions and means, with a significance level set at p<0.05.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Baseline age and cardiovascular risk factors were comparable, but sex distribution differed significantly (p = 0.016), with a higher proportion of women in the CRT group (40% vs. 24.3%). CRT patients showed significantly higher rates of heart failure NYHA classification > 2 (58.3% vs. 28.8%; p < 0.001), dilated cardiomyopathy (65% vs. 5.9%; p < 0.001), and reduced ejection fraction (<50% in 68.3% vs. 17.1%; p < 0.001) – <strong>Table 1</strong>. There were no significant differences in major extraction indication (infectious vs non-infectious), or previous extraction attempts. CRT patients had a greater number of leads removed (median 3 vs. 2; p < 0.001) and extraction techniques did not differ significantly between the two groups (p = 0.052), both being submitted more often to the PISA technique (73.3% CRT; 84.2% non-CRT) compared to simple traction (26.7% CRT; 15.8% non-CRT), even though lead dwell time was longer among CRT cases (median 84 vs. 108 months; p = 0.002) – <strong>Table 2</strong>. Overall clinical and radiological success rates were similar, as well as procedure-related major or minor complications and all-cause mortality – <strong>Table 3</strong>.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Coronary sinus lead extraction in CRT devices achieved comparable clinical and radiological success rates, complication rates, and all-cause mortality to those observed in non-CRT systems. These findings suggest that coronary sinus lead extraction is feasible and safe, with similar technical challenges to non-coronary lead extraction.</span></span></p>
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