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

Background/objectives: Binding sites are the principal cause of failed lead removal and complications, and are not directly visualized by fluoroscopy.Weaimed 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 b 0.05), and powered-sheath use (r=0.39, p b 0.05), and negatively with procedural success (r=−0.37, p b 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, andmight be beneficial for a tailored strategy.