Unexpected Procedure Difficulties Increasing the Complexity of Transvenous Lead Extraction: The Single Centre Experience with 3721 Procedures

Abstract

Background: Transvenous lead extraction (TLE) should be completed, even when facing difficulties which have yet to be described. The aim was to explore unexpected TLE obstacles (the circumstances of the occurrence and influence on TLE outcome). Methods: The retrospective analysis of a single centre database containing 3721 TLEs. Results: Unexpected procedure difficulties (UPDs) occurred in 18.43% of cases (singles in 12.20% of cases and multiples in 6.26% of cases). These included blockages in the lead venous approach in3.28% of cases, functional lead dislodgement in 0.91% of cases, and loss of broken lead fragment in 0.60% of cases. All of them, including implant vein—in 7.98% of cases, lead fracture during extraction—in 3.84% of cases, and lead-to-lead adherence—in 6.59% of cases, Byrd dilator collapse—in 3.41% of cases, including the use of an alternative prolonged the procedure but had no influence on long-term mortality. Most of the occurrences were associated with lead dwell time, younger patient age, lead burden, and poorer procedure effectiveness and complications (common cause). However, some of the problems seemed to be related to cardiac implantable electronic devices (CIED) implantation and the subsequent lead management strategy. A more complete list of all tips and tricks is still required. Conclusions: (1) The complexity of the lead extraction procedure combines both prolonged procedure duration and the occurrence of lesser-known UPDs. (2) UPDs are present in nearly one fifth of the TLE procedures, and can occur simultaneously. (3) UPDs, which usually force the extractor to expand the range of techniques and tools, should become part of the training in transvenous lead extraction.

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?

“…Unexpected procedure difficulties so-called technical problems during TLE, i.e., the situations that increased procedure complexity but were not complications [ 31 ]. They included break of extracted leads, loss of broken lead fragments when the main part of the lead was dissected and removed but both free ends remained in place, mobile lead fragments which flowed usually into the pulmonary vascular bed [ 31 ], blockage in lead venous entry/subclavian region preventing entry into the subclavian vein with a polypropylene catheter, Byrd dilator collapse/fracture [ 31 , 32 ], lead-to-lead adhesion [ 31 ], use of alternative approach [ 31 ] and dislodgement of functional leads [ 31 ].…”

“…ments which flowed usually into the pulmonary vascular bed [31], blockage in lead venous entry/subclavian region preventing entry into the subclavian vein with a polypropylene catheter, Byrd dilator collapse/fracture [31,32], lead-to-lead adhesion [31], use of alternative approach [31] and dislodgement of functional leads [31].…”

VDD Lead Extraction—Differences with Other Leads and Practical Tips in Management

“…Unexpected procedure difficulty caused so-called technical problems during TLE, i.e., situations that increased procedure complexity but were not complications [35]. They included break of extracted lead [26,[35][36][37][38][39][40][41][42][43][44], loss of broken lead fragments when the main part of the lead was dilated and removed but both free ends remained in place, mobile lead fragments that flowed usually into the pulmonary vascular bed [28,35,39], blockage in lead venous entry/subclavian region preventing entry into the subclavian vein with a polypropy-lene catheter, Byrd dilator collapse/fracture [35], lead-to-lead adhesion [35,40], necessity of using an alternative approach [35,40] and displacement of functional leads [35,40].…”

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

“…Over the last 17 years, the organization of lead removal has evolved from procedures performed in the electrophysiology laboratory using intravenous analgesia/sedation [22] to procedures in the hybrid room under general anesthesia. For the last seven years, the core extraction team has consisted of the same highly experienced extractor (now frequently serving as a proctor), an experienced echocardiographer, and dedicated cardiac surgeon [15,18,22,23].…”