Predictors of lead break during transvenous lead extraction

Abstract

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.

Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

“…A frequent technical problem during complicated TLEs was lead breakage. This is probably related to similar risk factors, as shown in the literature [32].…”

Usefulness of the controlled-rotation dilator sheath “Evolution RL” for extraction of old leads in two Japanese centers – An experience in use

“…Although lead age is a predictor of the incidence of lead breaks [16], there was no difference in the incidence of lead breaks between the two groups. The number of remaining tips was higher in leads older than 10 years, although the difference was not statistically significant.…”

“…The global trend in TLE indications is a balance between infected and non-infected indications, with an increasing proportion of noninfected indications [4,14]. In addition, passive fixation leads are more difficult to remove than active fixation leads owing to tip adhesion [19] and are one of the predictors of lead break [16]. Since the ICD lead is more likely to be an active fixation lead [12], the small number of ICD leads was another reason for the high percentage of passive fixation leads in our study.…”

Incomplete Lead Removal During the Extraction Procedure: Predisposing Factors and Impact on Long-Term Survival in Infectious and Non-Infectious Cases: Analysis of 3741 Procedures

“…Procedure complexity was expressed as extraction time of all leads (sheath-to-sheath time), average time of single lead extraction (sheath-to-sheath/number of extracted leads) and use of second line and advanced tools [27][28][29][30][31]. Unexpected technical problems during TLE, i.e., the situations that increased procedure complexity but caused no complications included fracture of targeted leads [4][5][6][7][8][9][10][11][12][13][14], loss of broken lead fragments [23][24][25][26], occlusion of lead implant vein in the subclavian region, Byrd dilator collapse/fracture [32], lead-onlead binding [33], use of alternative venous access [14,33] and dislodgement of functional leads [34].…”

“…The goal of TLE is to remove all targeted leads in their entirety with a minimal risk of major complications [1][2][3]. Fracture of the lead during the removal procedure is not a rare complication (a few percent) [4][5][6][7][8][9][10][11], but only several papers [12][13][14] and case reports have addressed the strategy of lead fracture management [15][16][17][18][19]. Furthermore, little attention has been paid to the predictive role of incomplete lead extraction [20][21][22].…”