Three-dimensional binding sites volume assessment during cardiac pacing lead extraction

Bich Lien Nguyen, Alessandro Persi, Eli S. Gang, Fabrizio Fattorini, Alessandra Oliva, Antonio Vitarelli, Nicola Alessandri, Robert J. Siegel, Antonio Ciccaglioni, Carlo Gaudio

Research output: Contribution to journalArticlepeer-review


Background/objectives Binding sites are the principal cause of failed lead removal and complications, and are not directly visualized by fluoroscopy. We aimed to assess binding sites between permanent cardiac pacing leads and cardiovascular structures using CartoSound™ three-dimensional (3D) imaging technology (Biosense Webster Inc., Diamond Bar, CA) during transvenous lead extraction, and compared outcomes to standard approach. Methods We recruited 291 patients undergoing percutaneous lead extraction, and 3D CartoSound anatomical mapping of the superior vena cava, right atrium (RA), coronary sinus, right ventricle (RV), pacing leads, and binding sites before, during, and after lead removal was randomly performed in 46 of them (38 men; mean age 73.7 ± 10.5 years; 1.96 leads/patient; mean time-from-implant of 62.7 ± 51.8 months) using a 10-Fr 3D SoundStar™ catheter and integrated into the Carto® mapping system. Results CartoSound was able to detect more intracardiac binding sites compared to fluoroscopy (RA 17.4% vs. 4.3%, p = 0.04; RV 43.5% vs. 21.7%, p = 0.04), but was unable to assess the subclavian/innominate veins. Binding sites volume correlated positively with time-from-implant (r = 0.38, p <0.05), and powered-sheath use (r = 0.39, p <0.05), and negatively with procedural success (r = - 0.37, p <0.05). When compared to standard approach, CartoSound use was characterized by a significantly lower mean procedure time (p = 0.0001), major complications (p = 0.03), and greater procedure success rates (p = 0.03). Conclusions Real-time 3D binding sites assessment is feasible and improves transvenous lead extraction outcomes. Its role as a complementary information requires extensive validation, and might be beneficial for a tailored strategy.

Original languageEnglish
Article number9
Pages (from-to)1-6
Number of pages6
JournalClinical Trials and Regulatory Science in Cardiology
Publication statusPublished - Jul 1 2015


  • Binding sites volume
  • Electro-anatomical mapping system
  • Imaging
  • Intracardiac echocardiography
  • Pacing lead extraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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