Minneapolis Heart Institute East, Arrhythmia Science Center, Minneapolis, Minnesota.
Department of Medicine, Montreal Heart Institute, Montreal, Canada.
Heart Rhythm. 2023 Jun;20(6):902-909. doi: 10.1016/j.hrthm.2023.02.025. Epub 2023 Mar 1.
With the advent of conduction system pacing, use of the Medtronic SelectSecure Model 3830 lead has increased substantially. However, with this increased use, the potential need for lead extraction also will increase. Lumenless lead construction requires an understanding of both applicable tensile forces as well as lead preparation techniques that can influence consistent extraction.
The purpose of this study was to use bench testing methodologies to characterize the physical properties of lumenless leads and to describe related lead preparation methods that support known extraction techniques.
Multiple 3830 lead preparation techniques, commonly used in extraction practices, were compared on the bench to assess rail strength (RS) in simple traction and use conditions with simulated scar. Retention of the IS1 connector vs severing the lead body preparation techniques were compared. Distal snare and rotational extraction tools were evaluated.
The retained connector method provided higher RS compared to the modified cut lead method: mean 11.42 lbf (9.85-12.73 lbf) vs 8.51 lbf (1.66-14.32 lbf), respectively. Snare use distally did not significantly affect RS: mean 11.05 lbf (8.58-13.95 lbf). Lead damage occurred with the TightRail extraction tool at angles ≥90°, which could occur with right-sided implants.
When extracting SelectSecure leads, the retained connector method to maintain cable engagement benefits preservation of the extraction RS. Limiting traction force to <10 lbf (4.5 kgf) and avoiding poor lead preparation methods are critical to consistent extraction. Femoral snaring does not change RS when needed and offers a method to regain lead rail in cases of distal cable fracture.
随着传导系统起搏的出现，美敦力 SelectSecure Model 3830 导联的使用量大幅增加。然而，随着使用量的增加，对导联拔除的潜在需求也将增加。无内腔导联结构需要了解适用的拉伸力以及可能影响一致拔除的导联准备技术。
本研究旨在使用台架测试方法来描述无内腔导联的物理特性，并描述支持已知拔除技术的相关导联准备方法。
在台架上比较了多种 3830 导联准备技术，这些技术通常用于拔除实践，以评估简单牵引和模拟瘢痕条件下的轨道强度（RS）。比较了保留 IS1 连接器与切断导联体的准备技术。评估了远端圈套和旋转拔除工具。
与修改后的切断导联方法相比，保留连接器方法提供了更高的 RS：分别为 11.42 磅力（9.85-12.73 磅力）和 8.51 磅力（1.66-14.32 磅力）。远端使用圈套不会显著影响 RS：平均值为 11.05 磅力（8.58-13.95 磅力）。在角度≥90°时，TightRail 拔除工具会导致导联损坏，这可能发生在右侧植入物中。
在拔除 SelectSecure 导联时，保留连接器的方法可以保持电缆连接，有利于保持 RS。将牵引力限制在<10 磅力（4.5 千克力）以内，并避免不良的导联准备方法，对于一致的拔除至关重要。股部圈套不会改变需要时的 RS，并在远端电缆断裂的情况下提供重新获得导联轨道的方法。
