Background The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. Methods We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. Results A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07‐1.17; P < .001), passive leads (OR 2.29 95% CI 1.09‐4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72‐6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03‐5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade. Conclusions Lead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.

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We report the case of a 74-year-old man with a previously implanted pacemaker lead. He had undergone Medtronic™ Micra Transcatheter Pacing System (TPS, Medtronic plc, MN, USA) implantation because of lead fracture. We implanted a new TPS and retrieved the dislodged one. We used a multiple-loop snare (EN snare®) and an 8.5F steerable sheath (Agilis NXT; St. Jude Medical, St Paul, MN, USA). The TPS was obstructed by the chordae tendineae of the tricuspid valve and the pacemaker lead. We pushed the TPS to the apex site; this enabled us to move the TPS away from the chordae tendineae and pacemaker lead. The TPS body was caught in the inferior vena cava and was successfully retrieved. To our knowledge, this is the first case reporting TPS retrieval in a heart with preexisting lead.

This case discusses the retrieval of a pacemaker with vegetation from a 78‐year‐old man. It suggests that grasping side of Micra body and pulling Micra into Agilis sheath is a possible technique for retrieval.