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Keyser, Andreas ; Schopka, Simon ; Jungbauer, Carsten ; Foltan, Maik ; Schmid, Christof

Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture

Article

Keyser, Andreas, Schopka, Simon, Jungbauer, Carsten, Foltan, Maik and Schmid, Christof (2018) Early-BYRD: alternative early pacing and defibrillation lead replacement avoiding venous puncture. Journal of Cardiothoracic Surgery 13 (1), pp. 1-5.

DOI to cite this document: 10.5283/epub.38409


Abstract

Background: In cases of lead failure after implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD) early lead replacement may be challenging. Puncture of the subclavian vein bears possible complications such as pneumothorax, hematothorax, and damage of leads to be left in place. To avoid venous puncture PM or ICD leads were replaced using a flexible polypropylene sheath ...

Background: In cases of lead failure after implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD) early lead replacement may be challenging. Puncture of the subclavian vein bears possible complications such as pneumothorax, hematothorax, and damage of leads to be left in place. To avoid venous puncture PM or ICD leads were replaced using a flexible polypropylene sheath (Byrd-sheath). Method: From January 2010 through December 2017, 55 patients underwent early lead exchange avoiding venous puncture. Early lead exchange for this study was defined as a reintervention within 14 days after the initial lead implantation. The connector of the malfunctioning lead was cut off, and stabilized by a stiff stylet. After having cut off the plastic knob of the stylet, the lead was passed through the polypropylene sheath and the latter advanced into the subclavian vein with gentle rotational movements to gain access to the subclavian vein. After lead removal the polypropylene sheath was replaced by a peel away sheath a new lead inserted. Results: Overall, 23 defibrillation leads and 34 pacing leads (16 right atrial leads, 17 right ventricular leads, and 1 left ventricular lead) were successfully explanted. Access to the subclavian vein was uneventful, and blood loss minimal. Radiation exposure and fluoroscopy time were also negligible. Conclusion: The Byrd-sheath technique proved to be safe and successful in providing vein access within 2 weeks after initial lead implantation using the previously implanted lead and thus avoiding puncture of the subclavian vein.



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Details

Item typeArticle
Journal or Publication TitleJournal of Cardiothoracic Surgery
PublisherBMC
Open Access TypeGold (with APC)
Place of PublicationLONDON
Volume13
Number of Issue or Book Chapter1
Page Rangepp. 1-5
Date1 December 2018
Date of publication01 Mar 2019 12:31
InstitutionsMedicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie
Medicine > Lehrstuhl für Innere Medizin II
Identification Number
ValueType
10.1186/s13019-018-0795-5DOI
KeywordsPACEMAKER; IMPLANTATION; EXTRACTION; Pacemaker; Implantable cardioverter defibrillator; Lead exchange; Polypropylene sheath; Venous puncture
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgYes
URN of the UB Regensburgurn:nbn:de:bvb:355-epub-384092
Item ID38409

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