Twenty-year experience of transvenous lead extraction at a single centre

Abstract

Aims: Indications for cardiovascular implantable electronic devices continue to evolve, which has led to an increasing requirement for transvenous lead extraction. We explore the indications, complications, and success rates involved in the removal of pacemaker and implantable cardioverter-defibrillator (ICD) leads in a high-volume centre, over 20 years.

Methods and results: We performed a retrospective analysis of all consecutive patients undergoing transvenous lead extraction by a single operator at a single centre between 1993 and 2012. Patient characteristics, indications, and outcomes were analysed. A total of 1006 leads were removed from 510 patients. Seventy-two per cent of patients were males. The mean age was 64 years (range 14-96). Indications included systemic infection (25%), pocket infection (40%), lead failure (26%), chronic pain (3%), and other (6%). Ninety-six per cent of leads were completely removed. There was one procedure-related death, and the major complication rate was 0.3%. Infection was the only identified predictor of increased complication (χ² for difference between groups 20, P< 0.0001).

Conclusion: Pacing and ICD leads can be safely extracted with mechanical techniques. The presence of device infection appears to be the major predictor of procedural complications.

Keywords: Infection; Internal cardioverter-defibrillator; Lead extraction; Pacemaker.