Lead extraction
- by majellasharkey
- 2012-05-15 05:05:57
- Complications
- 1325 views
- 7 comments
Hi everyone,
can anyone tell me if it is common practice to have atrial extraction without lazer and using the old fashioned 'traction' method.?
thanks
7 Comments
King Henry VIII...
by donr - 2012-05-15 10:05:38
...will lend you his headsman & his axe if you want it.
Why not, traction is about as obsolete.
If that lead is anchored by tissue in the vein, traction is difficult at best & impossible in most cases. There is a great article on lead extractions - I'll find its URL & post it to you in a few minutes.
Don
As Promised - article on lead extraction
by donr - 2012-05-15 11:05:31
I posted this comment about 2 months ago. Enjoy.
Don
Lead Extraction
Comment posted by donr on 2012-03-22 23:22.
Lizzie: It's done all the time! No, it is NOT a trivial procedure, so they don't do it just because you want an MRI safe PM. Below I've inserted a comment I made to someone else about lead extraction. It has a link to a very good paper explaining the pluses & minuses & risks involved. I faced a potential lead extraction several yrs ago & had a long discussion w/my EP about it.
Leads extraction is not performed at every hosp, either. It takes a very special person to become adept at it & every EP does not want to do it.
Your cardio quoting 5% mortality rate is pessimistic. It is more like 1% for a competent, well experienced EP - which is a far cry from 5%.
Wish you the best in your quest for info on this.
Begin Cut & Paste:
Want to read a scholarly work on this?
Comment posted by donr on 2012-03-10 09:50.
Last night, after reading at least three posts on lead extraction questions, I went to Google & found this PDF format document by the Heart Rhythm Society. All sorts of interesting info in it. Like what are the conditions for removing old leads. Criteria for a surgeon to be adequately trained & experienced in lead extraction. Mortality rates for the procedure (under 1% for an "Experienced" surgeon). It's a 45 page document, well written & truly interesting - IF you are a PM Host facing a potential lead extraction. recommendations on what type institution you should go to for the procedure.
http://www.hrsonline.org/news/media/press-releases/upload/leadextraction_cieds.pdf
End Cut & Paste
Mortality rates
by ElectricFrank - 2012-05-16 01:05:11
I'm not advocating any particular decision or approach, but though you might like to consider this:
1% mortality sounds pretty low and unlikely. This means that of every 100 procedures 1 person will die. To put that in perspective would you consider an airline trip if 1 of every 100 flights had a fatal accident? Or what if 1 of every 100 takeout pizza's had a fatal poison?
It helps to put these statistics in understandable form.
Great Percent Factor
by donb - 2012-05-17 11:05:22
I just love your example of 1% mortality rate. My 5% figure for my Lexiscan test put me in the ball-park of having a severe reaction. Happily I've survived for 3 months, have to go back for more blood work to see how this body is repairing the damage.
donb
Statistics
by ElectricFrank - 2012-05-18 12:05:53
I forgot to add that a 1 in 100 chance of death means nothing when applied to an individual. If I try to imagine what that means to me it goes nowhere.
Now if I was an insurance company dealing with thousands of customers the risk factor is a matter of Population Statistics, and is a reliable way of predicting payouts.
Strange,
frank
Ah, Statistics & Lies & Damned lies
by donr - 2012-05-19 08:05:09
Frank - my favorite issue w/ statistics! They cannot be reliably applied to an individual. After all, statistics are made up from data from a bunch of individuals! Some of them are 3 sigma to the right; some others are 3 sigma to the left. Some of them are actually right on the mean or median.
When you look at statistics as a measure of the capability of a surgeon, you have no idea what the population is that he/she operates on. You have no idea whatsoever where you as a patient stand in the universe of his patients. If you are going to some Dr. who just does easy, straightforward, low risk cases, it is significantly different than if he/she does a lot of very high risk, complex cases.
Another issue for folks in here - they are not generally looking at a procedure that is truly elective. Most of the time, the "Do Nothing" option is not a low risk option We have to choose among a bunch of options that have varying degrees of risk, so we are looking for essentially the least worst option of the many we face.
F'rinstance, on a lead extraction - a 1% mortality rate is a heck of a lot better than a 5% risk - GIVEN that the "Do Nothing " option could lead to some rather more serious consequences. Therefore, we must weigh the "Do Something" risk against the "Do Nothing" risk, as opposed to looking at it standing alone.
Don
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laser
by Tracey_E - 2012-05-15 08:05:39
I don't know if it's common or not but if I was having a lead extracted, I'd go for the latest technology and a surgeon that does it a LOT, like more than 100 a year. The newer lasers are a lot safer. The only exception would be if it's less than a year old, then laser isn't necessary, it can be pulled out.