Out with the old: Single center experience with transvenous extraction of leads older than 15 years

Abstract

Background: Lead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction.

Objectives: To report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years.

Methods: Procedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion.

Results: A total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high-volume center. Forty-one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty-six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, p value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure-related mortality.

Conclusions: Despite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.

Keywords: CIED management; Lead extraction.