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. 2023 Dec 11;12(24):7613.
doi: 10.3390/jcm12247613.

Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort

Axel Kloppe  1   2 , Julian Fischer  1 , Assem Aweimer  2 , Dominik Schöne  1 , Ibrahim El-Battrawy  2   3 , Christoph Hanefeld  4 , Andreas Mügge  2   3 , Fabian Schiedat  1   2
Affiliations

Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort

Axel Kloppe et al. J Clin Med. .

Abstract

Background: Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths.

Methods: Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares.

Results: In 463 patients (age 69.9 ± 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 ± 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time (p < 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy (p = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time (p = 0.01) and uninterrupted acetylsalicylic acid (p < 0.05).

Conclusion: A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction.

Keywords: cardiac electrical devices; transvenous lead extraction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Stacked bar chart illustrating success per tool and major complication associated with the tool.
Figure 2
Figure 2
Bar graph illustrating which tool was used for successful extraction in a stepwise approach and mean lead dwelling time.
Figure 3
Figure 3
Pie chart illustrating complication rate associated with a stepwise minimal-invasive approach for transvenous lead extraction.
See this image and copyright information in PMC

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