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The morphological conditions of the permanent pacemaker lead extraction

Dariusz Kozłowski, Adam Kosiński, Magdalena Kozłowska, Ada Dubaniewicz, Edyta Sidłowska, Michalina Pejska, Wojciech Homenda, Marek Grzybiak, Grzegorz Raczak

Med Sci Tech 2007; 48(4): RA243-247

ID: 881576

Introduction: Pacemaker lead extraction is the treatment of choice in infectious complication regarding implantation procedure. The purpose of this study was to estimate the extraction’s safety in relation to the morphological changes of the pacing electrode. Material and methods: Research was carried out on materials consisting of 60 human hearts from 45 to 95 years of age (avg. 63±15 yrs), with VVI or DDD pacing (pacing duration 84±26 months) fixed in a formalin solution. Classical macroscopic anatomical methods were applied. Results: In 44 hearts (73,3%) from the investigated group the posterior tricuspid leaflet was thickened only and in 24 of these hearts the process regarded not only posterior leaflet but also the septal one and especially comissure between them. In 52 hearts (86,6%) inflammatory reaction spread also to the neighbouring part of the electrode. The length of the neointima-inflammatory tissue ranged between 4-8 mm (avg. 5±2 mm). On the electrode’s tip in the right ventricle cavity in 56 hearts (93,3%) we observed that endocardial leads were surrounded by fibrous thickening , and partially covered by endocardial tissue. Conclusions: We concluded that from the anatomical point of view the extraction of the pacing electrode seems to be questionable, especially in the long-term permanent pacing. The experimental traction shaws that electrodes with recent implantation succeeded to remove without any complications and in other with fraction of the tip, myocardial tissue avulsion or electrode did not succeed to remove at all . (Clin Exp Med Lett 2007; 48(4): 243-247)

Keywords: anatomical conditions of extraction, morphology of the permanent pacing, functionless chronic leads

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