{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:25:44Z","timestamp":1747149944737,"version":"3.40.5"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T00:00:00Z","timestamp":1632268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Transvenous lead extraction (TLE) for implantable cardiac\u2010devices is traditionally performed under general anesthesia (GA). This can lead to greater risk of exposure to COVID\u201019, longer recovery\u2010times and increased procedural\u2010costs. We report the feasibility\/safety of TLE using conscious\u2010sedation alone with immediate GA\/cardiac\u2010surgery back\u2010up if needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective case\u2010series of consecutive TLEs performed using conscious\u2010sedation alone between March 2016 and December 2019. All were performed in the electrophysiology\u2010laboratory using intravenous Fentanyl, Midazolam\/Diazepam with a stepwise approach using locking\u2010stylets\/cutting\u2010sheaths, including mechanical\u2010sheaths. Baseline patient\u2010characteristics, procedural\u2010details and TLE outcomes (including procedure\u2010related complications\/death) were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 130 leads were targeted in 54 patients, mean age\u00a0\u00b1\u00a0SD 74.6\u00a0\u00b1\u00a011.8years, 47(87%) males; dual\u2010chamber pacemakers (n\u00a0=\u00a026; 48%), cardiac resynchronization therapy\u2010defibrillators (n\u00a0=\u00a017; 31%) and defibrillators (n\u00a0=\u00a08; 15%) were commonest extracted devices. Mean\u00a0\u00b1\u00a0SD\/median (range) lead\u2010dwell times were 11.0\u00a0\u00b1\u00a08.8\/8.3 (0.3\u201037) years, respectively. Extraction indications included systemic infection (n\u00a0=\u00a023; 43%) and lead\/pulse\u2010generator erosion (n\u00a0=\u00a027; 50%); mean 2.1\u00a0\u00b1\u00a02.0 leads were removed per procedure\/mean procedure\u2010time was 100\u00a0\u00b1\u00a054\u00a0min. Local anesthetic (LA) was used for all (mean\u2010dose: 33\u00a0\u00b1\u00a08\u00a0ml 1% lidocaine), IV drug\u2010doses used (mean\u00a0\u00b1\u00a0SD) were: midazolam: 3.95\u00a0\u00b1\u00a02.44\u00a0mg, diazepam: 4.69\u00a0\u00b1\u00a00.89\u00a0mg and fentanyl: 57\u00a0\u00b1\u00a040\u00a0\u00b5g. Complete lead\u2010extraction was achieved in 110 (85%) leads, partial lead\u2010extraction (&lt;4\u00a0cm\u2010fragment remaining) in 5 (4%) leads. Sedation\u2010related hypotension requiring IV fluids occurred in 2 (managed without adverse\u2010consequences) and hypoxia requiring additional airway\u2010management in none. No procedural deaths occurred, one patient required emergency cardiac surgery for localized ventricular perforation, nine had minor complications (transient hypotension\/bradycardia\/pericardial effusion not requiring intervention).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TLE undertaken using LA\/conscious\u2010sedation was safe\/feasible in our series and associated with good clinical outcome\/low procedural complications. Reduced risk of aerosolization of COVID\u201019 and quicker patient recovery\/reduced anesthetic risk are potential benefits that warrant further study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/joa3.12637","type":"journal-article","created":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T18:42:57Z","timestamp":1632336177000},"page":"1522-1531","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety and feasibility of trans\u2010venous cardiac device extraction using conscious sedation alone\u2014Implications for the post\u2010COVID\u201019 era"],"prefix":"10.1002","volume":"37","author":[{"given":"Thomas","family":"Lachlan","sequence":"first","affiliation":[{"name":"Department of Cardiology University Hospitals Coventry &amp; Warwickshire NHS Trust Coventry UK"},{"name":"University of Warwick (Medical School) Coventry UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hejie","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospitals Coventry &amp; 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