Step by Step through the Years—High vs. Low Energy Lead Extraction Using Advanced Extraction Techniques

Abstract

Background: Limited data is available about the outcome of TLE in patients with vs. without high energy leads in the last decade. Methods: This is an analysis of consecutive patients undergoing TLE at a high-volume TLE centre from 2001 to 2021 using the stepwise approach. Baseline characteristics, procedural details and outcome of patients with high energy lead (ICD group) vs. without high energy lead (non-ICD group) were compared. Results: Out of 667 extractions, 991 leads were extracted in 405 procedures (60.7%) in the ICD group and 439 leads in 262 procedures (39.3%) in the non-ICD group. ICD patients were significantly younger (median 67 vs. 74 years) and were significantly less often female (18.1% vs. 27.7%, p < 0.005 for both). Advanced extraction tools were used significantly more often in the ICD group (73.2% vs. 37.5%, p < 0.001), but there were no significant differences in the successful removal (98.8% vs. 99.2%) or complications (4.7% vs. 3.1%) between the groups (p > 0.2 for both). Discussion: Using the stepwise approach, overall procedural success was high and complication rate was low in a high-volume centre. In patients with a high energy lead, the TLE procedure was more complex, but outcome was similar to comparator patients.

Single center experience with the novel rotating dilator sheath TightRailTM Sub‐C in transvenous lead extraction

“…Conversely, there are multiple studies reporting higher major complication rates after TLE, underscoring the importance of variable patient characteristics and definitions of complications. [17][18][19] In comparison to a contemporary review of TLE summarizing major complication rates of 0%-7.3% in previous studies, our rate of 4.4% major complication lies within the anticipated boundaries. 20 The potential advantages of the TightRail TM devices are the softer shaft (offering higher flexibility and better co-axiality during the…”

“…The potential longer dwell time of the leads may result in a higher risk procedure, but also the lower patient number in our cohort may statistically influence the results. Conversely, there are multiple studies reporting higher major complication rates after TLE, underscoring the importance of variable patient characteristics and definitions of complications 17–19 . In comparison to a contemporary review of TLE summarizing major complication rates of 0%–7.3% in previous studies, our rate of 4.4% major complication lies within the anticipated boundaries 20 …”

Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

“…Zweiker at al. described their experience with lead extraction in 667 TLE procedures [ 38 ]. They extracted ICD leads in 34.8%, CRT-D in 33.7%, PM in 31.6% of patients and extracted lead average dwell time was 64.6 months; for ICD group 66.9—and for PM group—61.5 months.…”

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?

“…More and more patients are receiving intracardiac ICD leads and their malfunction and infections result in an increase in the rate of their removal [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Available evidence suggests that the number of single-coil lead implantations is increasing [ 14 , 16 , 17 ] with satisfying outcomes [ 17 , 18 , 19 ].…”

“…Lead extraction is a highly effective procedure but carries a risk of major complications [ 21 , 22 , 23 ]. For a very long time, the necessity to extract an ICD lead has been considered a risk factor for developing major complications [ 2 , 9 , 10 , 11 , 13 , 14 ] although a few reports have not confirmed this observation [ 8 , 12 , 15 ]. 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 ].…”