Is the transvenous extraction of cardioverter-defibrillator leads more hazardous than that of pacemaker leads?

Abstract

Background: Leads used for low-voltage and high-voltage therapy delivered by implantable cardioverter-defibrillators (ICD) differ from low-voltage pacemaker (PM) leads in their diameter and complexity of structure. Although there are reports showing that the extraction of ICD leads may be hazardous, due to firm adhesions to the vascular and chamber walls of high-voltage therapy coils, clinical evidence suggests that such procedures are safe.

Aim: To compare the efficacy and safety of transvenous extraction of ICD and PM leads in patients enrolled in a single tertiary centre.

Methods: We compared the results of lead extraction procedures in 345 patients with PM and in 79 patients submitted for the lead removal including at least one ICD lead. We analysed ingrown leads i.e. over 12 month-old PM leads and over 6 month-old ICD leads, which were removed using Cook's device.

Results: Patients in the two groups differed significantly in age and gender. The ICD systems were significantly younger, less complex (fewer leads per patient) and presented higher efficacy of extraction and fewer technical difficulties. The number of major complications was similar to the encountered during extraction of PM leads. However, minor complications were significantly more frequent in the ICD group.

Conclusions: 1. Extraction of ICD and PM leads is associated with a similar risk for developing major complications, however minor complications are more often during extraction of ICD leads. 2. A larger number of double coil leads may be the cause of complications despite a shorter time period elapsing from ICD implantation. 3. A probable cause of complications during ICD lead extraction is the pronounced growth of the connective tissue around the coils. However, further studies are required to clarify this phenomenon. 4. The success rate of ICD leads extraction using our own surgical technique is similar to that reported by other investigators using laser systems.