Vatterott Pierce, Finley James, Savela Jordan, De Kock Andrew, Lewis Robert
Arrhythmia Science Center Minneapolis Heart Institute, Minneapolis, Minnesota.
Boston Scientific, St. Paul, Minnesota.
Heart Rhythm. 2024 Jun;21(6):929-938. doi: 10.1016/j.hrthm.2024.01.005. Epub 2024 Jan 11.
Traction force that can be applied to an extraction rail is based on lead tensile strength, a product of its construction. A strong rail allows safe advancement of the extraction sheath. This study expands previous work providing strategies to optimize INGEVITY rail strength.
The purpose of this study was to measure forces that leads encounter in a simulated extraction procedure, determine lead response, and develop extraction recommendations for INGEVITY, INGEVITY+, and FINELINE II lead families.
Leads were positioned in a simulated right atrial appendage implant. Subsequent traction forces enabled evaluation of lead tensile strength and effectiveness of preparation/extraction techniques.
Significant findings include (1) preserving the lead terminal pin did not decrease lead tensile strength and typically maximized it; (2) the weakest region is between the cathode and anode; (3) mid lead scar increases traction force tolerance until that scar is removed; and (4) optimal rail strength was observed using a multivenous approach with a femoral snare. Unique lead family findings include increased tensile strength of FINELINE II polyurethane vs silicone and INGEVITY active fixation vs passive fixation.
This study teaches the implanting clinician there are specific extraction techniques available to improve the removal of leads that may be the best option for a patient's clinical needs. Bench testing demonstrates that lead construction drives lead behavior during an extraction. Preserving the lead terminal pin provides consistent and, in most cases, optimal rail strength. If clinically indicated, a multivenous approach using a femoral snare significantly increases rail strength and protects the vulnerable lead tip.
可施加于拔除导线的牵引力基于导线的拉伸强度，这是其结构的一个产物。坚固的导线能够确保拔除鞘安全推进。本研究扩展了先前的工作，提供了优化INGEVITY导线强度的策略。
本研究旨在测量导线在模拟拔除过程中所遇到的力，确定导线的反应，并为INGEVITY、INGEVITY+和FINELINE II导线系列制定拔除建议。
将导线放置在模拟的右心耳植入物中。随后的牵引力可用于评估导线的拉伸强度以及准备/拔除技术的有效性。
重要发现包括：（1）保留导线末端引脚不会降低导线拉伸强度，且通常能使其最大化；（2）最薄弱区域位于阴极和阳极之间；（3）导线中部瘢痕会增加牵引力耐受性，直到该瘢痕被去除；（4）使用多静脉途径结合股静脉圈套器可观察到最佳的导线强度。各导线系列的独特发现包括FINELINE II聚氨酯导线相较于硅胶导线的拉伸强度增加，以及INGEVITY主动固定导线相较于被动固定导线的拉伸强度增加。
本研究告知植入临床医生，有特定的拔除技术可用于改善导线的拔除，这些技术可能是满足患者临床需求的最佳选择。台架测试表明，导线结构在拔除过程中决定了导线的表现。保留导线末端引脚可提供一致的，且在大多数情况下最佳的导线强度。如果临床有指征，使用股静脉圈套器的多静脉途径可显著增加导线强度并保护易受损的导线尖端。
