Abstract
Background: Lead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction. Objectives: To report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years. Methods: Procedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion. Results: A total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high-volume center. Forty-one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty-six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, p value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure-related mortality. Conclusions: Despite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.
Original language | English (US) |
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Pages (from-to) | 977-979 |
Number of pages | 3 |
Journal | PACE - Pacing and Clinical Electrophysiology |
Volume | 47 |
Issue number | 7 |
DOIs | |
State | Published - Jul 2024 |
Keywords
- CIED management
- Lead extraction
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine