Work

Factors associated with complexity during transvenous lead extraction and confirmation of a very-low-risk subset

Year: 2025

Type: article

Abstract: Background Transvenous lead extraction/explantation (TLE) requires significant resources/coordination. Objective We sought to assess factors associated with the need for complex tools or a major intraoperative complication (complexity) with TLE. Methods This was a single-center, retrospective cohort study in patients undergoing TLE between January 2010 and March 2022. Results There were 930 TLEs in 868 patients (age 62.9 ± 15.8 years, 68% men, 63% implantable cardioverter-defibrillators [ICDs], 1588 extracted leads, 29% infected). The median age of the oldest lead was 4.9 years (interquartile range, 1.9–8.1). Complex tools were used for 59.9% of TLE, including the laser (37.2%), laser and mechanical sheaths (9.2%), mechanical sheath (9.1%), snare and laser/mechanical (4.2%), and snare alone (0.1%). Complete success was achieved in 892 TLEs (95.9%). Complexity occurred with 59.9% of TLE (n = 557). Unplanned complexity occurred in only 2 of 203 pacemakers (1.0%), with the oldest lead being <2 years old and ICDs with the oldest lead being <1 year old. Factors independently associated with complexity included: number of ICD leads ( P < .0001), combined lead age ( P < .0001), number of transvenous leads ( P < .001), abandoned leads ( P = .0058), age at the time of implantation ( P = .019), oldest lead age ( P = .025), and patient age at TLE ( P = .025). Major intraoperative complications occurred with 10 TLEs (1.1%). No major intraoperative complications occurred with traction alone. Conclusion Factors associated with complexity included the presence of an ICD, abandoned leads, patient age, and the number/age of leads. The risk of unplanned complexity is low for pacemaker leads <2 years and ICDs <1 year since implantation. This subset can be considered for TLE in the electrophysiology laboratory without immediate cardiac surgical backup.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2025.11.004