Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads

Abstract

Aims Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. Methods and results Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07–11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01–1.02; P < 0.001) were associated with a higher risk of clinical failure. Conclusion Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.

Transvenous Lead Extraction without Procedure-Related Deaths in 1000 Consecutive Patients: A Single-Center Experience

“…In the present study, the implant duration was markedly longer (112 months), and there were two smaller studies reporting such a long lead dwell time. 29,40 Infection was the main indication for lead extraction in 41.7% of reports. In the current study, this percentage was lower (22%), and there were only 3 studies with a higher rate of non-infectious indications.…”

“…26,30,34 Laser sheaths were used as a first-line or predominant (50%) tool in 11 reports comprising 22,890 patients. 13,24,25,27,28,30,[32][33][34]36,38 Mechanical dilation with non-powered sheaths was used as a first-line or predominant (50%) option in 11 reports comprising 17,953 patients, 15,22,23,26,29,31,35,39,40,42 whereas mechanical rotational sheaths with threaded tips were used as a first-line or predominant (50%) tool in 2 reports 35,38 (a relatively new tool; 2,605 patients). In one report, femoral approach and Needle's Eye Snare was used as a first-line option in 492 patients.…”

Looking for Lead Adhesions While Planning for Transvenous Lead Extraction

“…18 Device factors including number of leads, type of leads and the presence of abandoned leads may play a role. 18,[21][22][23][24] Finally, center and operator experience may influence the risk of TLE. 15,25 While the difference in complications in patient with lead-venous adherence in this study did not reach statistical significance, other studies support an association.…”

Looking for lead adhesions while planning for transvenous lead extraction

“…18 Device factors including the number of leads, type of leads, and the presence of abandoned leads may play a role. 18,[21][22][23][24] Finally, center and operator experience may influence the risk of TLE. 15,25 While the difference in complications in patients with leadvenous adherence in this study did not reach statistical significance, other studies support an association.…”