Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes

Abstract

Background: The practice of lead abandonment at the time of cardiac implantable electronic device upgrade remains a controversial topic but is affecting an increasing number of patients. Inherent risks include high-risk extractions of redundant leads when extraction is required at a later date.

Objectives: We aimed to report our experience with transvenous lead extraction (TLE) at the time of device upgrade.

Methods: All consecutive TLE procedures at the time of device upgrade at the Cleveland Clinic between January 1, 1996 and December 31, 2012 were included (n = 503). Success and complications were defined according to the Heart Rhythm Society consensus document on TLE.

Results: There were a total of 984 leads in place, and 719 were targeted with extraction (589 pacer and 130 defibrillator leads, 63 of them being dual-coil leads). In all patients, TLEs aimed to avoid abandoning leads. Concomitant lead management issues included lead malfunction (15%), previously abandoned leads (9%), vascular access occlusion (6%), or leads on advisory (3%). In most procedures (75.4%), special extraction tools were needed. The complete procedural and clinical success rates were 96.6% and 97.2%, respectively. During planned extractions, damage of coexisting leads occurred in 19 patients (3.8%), eventually requiring extraction. The major and minor complication rates were 1% and 1.4%, respectively.

Conclusion: In a high-volume center, TLEs at the time of device upgrade were successful in the vast majority of patients with a low complication rate.

Keywords: CIED upgrade; Implantable cardioverter-defibrillator; Lead extraction; Outcome; Pacemaker.