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. 2023 Mar 14;12(6):2260.
doi: 10.3390/jcm12062260.

Success and Complication Rates of Transvenous Lead Extraction in a Developing High-Volume Extraction Center: The Zurich Experience

Daniel Hofer  1 , Noah Kuster  1 , Michelle C Bebié  1 , Tom Sasse  1 , Jan Steffel  1 , Alexander Breitenstein  1
Affiliations

Success and Complication Rates of Transvenous Lead Extraction in a Developing High-Volume Extraction Center: The Zurich Experience

Daniel Hofer et al. J Clin Med. .

Abstract

Introduction: Transvenous lead extractions are increasingly performed for malfunction or infection of cardiac implantable electronic devices, but they harvest a potential for complications and suboptimal success. Apart from multicenter registries and reports from highly experienced single centers, the outcome in individual newly developing high-volume centers starting a lead extraction program is less well established. We aimed to evaluate the clinical and radiological success and complication rate at our center, having started a lead extraction program less than a decade ago.

Methods: We retrospectively analyzed patients who underwent transvenous lead extraction at the University Hospital Zurich from 2013 to 2021 regarding success as well as complications and compared our results to previously reported outcome rates.

Results: A total of 346 patients underwent 350 transvenous lead extractions from January 2013 to December 2021. Combined radiological success was achieved in 97.7% and clinical success in 96.0% of interventions. Procedure-related major complications occurred in 13 patients (3.7%). Death within 30 days after transvenous lead extractions occurred in 13 patients (3.7%), with a procedure-related mortality of 1.4% (five patients).

Summary: Transvenous lead extractions in newly developing high-volume centers can be performed with high clinical and radiological success rates, but procedure-related major complications may affect a relevant number of patients. Compared to large single or multicenter registries of experienced centers, the success rate may be lower and the complication rate higher in centers newly starting with lead extraction, which may have important implications for patient selection, procedural planning, proctoring, and safety measures.

Keywords: complication; lead extraction; outcome; single center; success.

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Conflict of interest statement

Daniel Hofer reports educational grants, consultant or speaker fees, and fellowship support from Abbott, Medtronic, Biotronik, Boston Scientific, Biosense Webster, Novartis, Bayer, Pfizer, and Spectranetics. Alexander Breitenstein has received consultant and/or speaker fees from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Bristol-Myers Squibb, Cook Medical, Daiichi Sankyo, Medtronic, Pfizer, and Spectranetics/Philipps. Jan Steffel has received consultant and/or speaker fees from Abbott, Alexion, Astra-Zeneca, Bayer, Berlin-Chemie, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medscape, Medtronic, Menarini, Merck/MSD, Organon, Pfizer, Saja, Servier, andWebMD. He reports ownership of CorXL and Swiss EP. Steffel has received grant support through his former institution from Abbott, Bayer Healthcare, BiosenseWebster, Biotronik, Boston Scientific, Daiichi Sankyo, and Medtronic. Sasse reports educational grants from Biotronik.

Figures

Figure 1
Figure 1
X-ray during lead extraction with combined superior and femoral approach.
Figure 2
Figure 2
Radiological success or failure following transvenous lead extraction. Out of 350 TLE performed (100%), 323 TLE (92.3%) resulted in complete radiological success, 16 TLE (4.6%) resulted in partial radiological success, and 11 TLE (3.1%) resulted in radiological failure. TLE: transvenous lead extraction.
Figure 3
Figure 3
Complications following transvenous lead extraction. Out of 350 TLE performed (100%), 272 TLEs (77.7%) went flawlessly. A total of 68 TLEs (19.4%) resulted in minor complications, 19 TLEs (5.4%) resulted in major complications, and a subgroup of 13 TLEs (3.7%) resulted in major procedure-related complications. One procedure may be listed in multiple groups. TLE: transvenous lead extraction.
Figure 4
Figure 4
Frequency of major complications. Absolute number in relation to 350 TLEs in brackets. TLE: transvenous lead extraction.
Figure 5
Figure 5
Ratio between TLEs performed and major complications by year. There was an overall increase in TLEs performed from 2013 to 2021. However, the absolute number of major complications was stable, with a subsequent decrease in relative risk. TLE: transvenous lead extraction.
See this image and copyright information in PMC

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