Minimally Invasive Extraction Of Superfluous Leads: Worth The Effort?
Samer Hakmi, Simon Pecha, Nils Gosau, Stephan Willems, Hermann Reichenspurner.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: Despite the increasing number of lead extraction procedures and the proven efficacy and safety of those procedures in many studies, the transvenous extraction of superfluous leads is still debatable. We therefore investigated the outcomes and complications in patients received transvenous extraction of superfluous leads in a single-center experience over 10 years.
METHODS: Medical records of all patients undergoing transvenous lead extraction between January 2006 and August 2016 were retrospectively reviewed. We treated 513 patients using different minimally invasive lead extraction tools (laser sheath, mechanical sheath and/or snare) with a lead age of ≥ 24 months. Of these, 185 procedures were performed for superfluous leads. Causes for lead extraction were; lead dysfunction 99 (53.5%), device upgrade 39 (21.1%), lead recall 28 (15.1%), abandoned leads after HTX 5 (2.7%), tricuspid regurgitation 4 (2.2%), need for MRI application 3 (1.6%), lead migration 3 (1.6%), venous stasis 2 (1.1%) and chronic pain 2 (1.1%).
RESULTS: We treated 236 superfluous leads in 185 patients, including 149 pacing and 87 ICD leads. Mean time from initial lead implantation was 73.3 ± 28.2 months. Patients were 55.6 ± 17.2 years of age, 121 were male (65.4%) and 64 female (34.6%). Forty-six patients (24.9%) had ejection fraction below 30%. Fifty-one patients in our cohort had a previous cardiac surgery. The overall complication rate was 1.6% including one minor complication 0.5% (pocket hematoma) and two major complications 1.1% (emergent sternotomy). No extraction related mortality was observed. The complete procedural success rate for the removal of superfluous leads was high 97.5% associated with 100% clinical success rate.
CONCLUSIONS: Transvenous extraction of superfluous leads is highly successful. Due to the rarity of minor and major complications, the extraction of these leads is considered reasonable to avoid further complications with lead aging.
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