Purpose The use of cardiac implantable electronic devices (CIEDs) has increased significantly over the last decades. With the development of transvenous lead extraction (TLE), procedural success rates also improved; however, data regarding long-term outcomes are still limited. The aim of our study was to analyze the outcomes after TLE, including reimplantation data, all-cause and cause-specific mortality. Methods Data from consecutive patients undergoing TLE in our institution between 2012 and 2020 were retrospectively analyzed. Periprocedural, 30-day, long-term, and cause-specific mortalities were calculated. We examined the original and the revised CIED indications and survival rate of patients with or without reimplantation. Results A total of 150 patients (age 66 ± 14 years) with 308 leads (dwelling time 7.8 ± 6.3 years) underwent TLE due to pocket infection (n = 105, 70%), endocarditis (n = 35, 23%), or non-infectious indications (n = 10, 7%). All-cause mortality data were available for all patients, detailed reimplantation data in 98 cases. Procedural death rate was 2% (n = 3), 30-day mortality rate 2.6% (n = 4). During the 3.5 ± 2.4 years of follow-up, 44 patients died. Arrhythmia, as the direct cause of death, was absent. Cardiovascular cause was responsible for mortality in 25%. There was no significant survival difference between groups with or without reimplantation (p = 0.136). Conclusions Despite the high number of pocket and systemic infection and long dwelling times in our cohort, the short-and longterm mortality after TLE proved to be favorable. Moreover, survival without a new device was not worse compared to patients who underwent a reimplantation procedure. Our study underlines the importance of individual reassessment of the original CIED indication, to avoid unnecessary reimplantation.

Aims During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools. Methods and results Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 ± 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 ± 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01–0.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery. Conclusion The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.

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Funding Acknowledgements Type of funding sources: None. Background Transvenous lead extraction of apically positioned right ventricular (RV) leads could be more challenging compared to septal leads, however there is no scientific evidence regarding this issue. The aim of this study was to evaluate the impact of the RV lead position on extraction outcomes. Methods Data from consecutive patients undergoing transvenous lead extraction between 2014 and 2022 were retrospectively analysed. Extracted RV leads were divided into apical and non-apical groups, according to the preoperative chest X-ray images. Complete success rate of lead extraction was compared between the two groups. Results A total of 197 patients (mean age 65±14 years, 73,6% male, mean EF 50%) underwent transvenous lead extraction of 408 leads due to pocket infection (n=132, 67%), endocarditis (n=40, 20%), or non-infectious indications (n=25, 13%). 218/408 (53%) leads were right ventricular, of which 142 (65%) were extracted from an apical and 42 (19%) from a non-apical position, respectively. 34 cases (16%) with RV leads in both locations or RV leads previously pulled back from the right ventricle were excluded. There was no significant difference in the ratio of ICD leads or dual-coils between the two groups, however apical electrodes were older and had more frequently passive fixation compared to non-apical RV leads. Locking stylets, powered sheaths or snare technique were used in 88%, 82% and 30%, respectively, without any significant difference between the two groups. The complete success rate of lead extraction was higher in the non-apical group compared to apical leads (97,7% vs. 83,2%) (Odds Ratio (OR) 0,12; 95% CI 0,16-0,92; p=0,04). After adjustment for typical risk factors of extraction failure (i.e. age of leads, ICD leads, dual-coils, passive fixation) the difference become non-significant (adjusted OR 0,24; 95% CI 0,03-2,08; p=0,19). Conclusion In this single-centre, high-risk patient cohort we found better success rate of RV lead extraction from non-apical positions compared to apical leads, without statistically significant difference on multivariate analysis. Our results are hypothesis generating, and call for further research evaluating the impact of the RV lead position on extraction outcomes with larger patient populations.