LECOM (Lead Extraction COMplexity): A New Scoring System for Predicting a Difficult Procedure

Abstract

(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis of 3741 TLE procedures with and without complicating factors (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a five-point Complex Indicator of Difficulty of (TLE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicate a higher level of procedure complexity. (3) Results: Patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous procedures, passive fixation and multiple leads to be extracted, and a ratio of dwell time of oldest lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrates that a point total (being the sum of the odds ratios of the above variables) of >9.697 indicates a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, a logistic function was calculated, and we constructed a simple equation for lead extraction complexity that can predict the probability of a difficult procedure. The risk of complex extraction (as a percentage) is calculated as [1/(1 + 55.34 · 0.754X)] · 100 (p < 0.001). (4) Conclusion: The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management.

Analysis of 1051 ICD Leads Extractions in Search of Factors Affecting Procedure Difficulty and Complications: Number of Coils, Tip Fixation and Position—Does It Matter?

“…As a result, the procedural success rate was higher in ICD patients (98.29% vs. 94.04%). In this regard, these results corroborate the findings of other studies [ 8 , 12 , 15 , 28 ]. However, these observations do not justify the statement that extraction of ICD leads is easier, simpler and less risky because the groups are incomparable in terms of implant duration.…”

“…The dwell time of targeted ICD leads seems to be of crucial importance [ 4 , 5 , 11 , 13 , 15 , 28 ]. It is considered a risk factor for both major complications [ 4 , 11 , 13 ] and increased difficulty and complexity of the procedure [ 5 , 15 , 28 ].…”

“…Because each of the three commonly used procedure complexity indicators assesses one of three aspects of the issue we have elaborated although already published, comprehensive procedure complexity indicator that simultaneously represents all three forms of procedure difficulty (time and labor intensity of the procedure, the need to use advanced tools and advanced techniques) [ 28 ]. The fourth (new) complexity marker was the Complex Indicator of the Difficulty of the TLE (CID-TLE) which includes global sheath-to-sheath time for extraction of all leads >20 min (2 points), average duration of single lead extraction (sheath-to-sheath time) >12 min (2 points) and the necessity of using metal sheaths or Evolution/TightRail, alternative approach or lasso catheters or basket catheters (one point each).…”

“…The sum of points was the value of CID-TLE. The procedure was deemed to be difficult when CID-TLE was ≥2 [ 28 ].…”

“…In the last twenty years, ICD leads have become thinner and more isodiametric; however, they can still contribute to major complications [ 10 , 14 , 24 ], and in studies addressing lead extraction complexity ICD leads were regarded as a risk factor for more difficult and complicated procedures requiring the use of advanced techniques and tools [ 7 , 8 , 12 , 14 , 15 , 25 , 26 , 27 ]. In addition, the mechanism of lead fixation seems to be important as the removal of a passive fixation lead increases procedure complexity [ 25 , 28 ]. Because of possible interference, the decision to replace a malfunctioning ICD lead or to abandon it and implant a new one raises even more controversy than in pacing lead management [ 29 ].…”