Atrial lead perforation early after device implantation-a case report and literature review.

We report three patients with screw-in lead perforation in the right atrial free wall not long after device implantation. All the patients complained of intermittent stabbing chest pain associated with deep breathing during the implantation. The "dry" epicardial puncture was utilized to avoid hemopericardium during lead extraction in the first case. The atrial electrode was repositioned in all cases and replaced by a new passive fixation lead in two patients with resolution of the pneumothorax or pericardial effusion. A literature review of 50 reported cases of atrial lead perforation was added to the findings in our case report.

Snare sheath versus evolution sheath in transvenous lead extraction.

Lead extraction remains a challenging procedure with significant success. Owing to the increasing use of cardiac implantable electronic devices, there is a growing need for effective techniques management, to avoid the occurrence of device-related complications and lead dysfunction. We made a comparison of Evolution sheath and Needles Eye Snare sheath (abbreviated to Snare sheath) by analyzed the results using two kind of the methods in the Cardiology Center of Peking University People's Hospital. In the retrospective study we evaluated patients who underwent lead extraction from July 2013 to July 2014. Those who underwent lead removal without using evolution or snare were excluded. Primary endpoints included total exposure time, operation time, and complications. Data on clinical characteristics, indications, and outcomes were prospectively collected and analyzed. A total of 76 patients were included in the study (65.8% male; aged 68.1±14.34 years old). Snare and Evolution were used in 59 and 17 patients, respectively. A total of 134 leads were removed with 103 leads (76.87%) extracted using the Snare sheath. Lead age was 10.8±7.0 years. Complete extraction was observed in 67 patients of 124 leads. Evolution sheath was associated with significantly lower complication even after adjustment of the number of leads, type of leads, and lead age, compared to the Snare group (P<0.05). In the Snare sheath group, mortality rate was 1.69% and minor complication rate was 3.39%. When compared to the Snare sheath, lead extraction with the Evolution sheath has less X-ray exposure time and less operation time (P<0.05), while with a higher success rate (P<0.05). Besides, the Evolution group has fewer major and minor complications.