Pacing and implantable cardioverter-defibrillator transvenous lead extraction

During the last 20 years, the transvenous techniques for the extraction of chronically implanted pacing (PL) and defibrillating leads (DL) achieved a high success rate. However the procedures are often complex and are associated with a small but significant risk. The operators' experience and the availability of different approaches for difficult cases seem to affect both the results and the complications. This paper represents a review of indications, techniques and results of a 10-year experience in the field of transvenous lead extraction. Since January 1997, extraction was attempted in 1330 leads; among these 1137 were successfully extracted with the standard mechanical approach (success rate 85.4%); in 12 leads was performed a partial extraction (0.9%) and 1 was inapplicable (0.07%). The jugular approach was performed in 180 leads (164 PL and 16 DL): 39 were intravascular free-floating leads (38 PL and 1 DL) and 141 were difficult exposed leads (126 PL and 15 DL) allowing extraction in 178/180 (98.8%) cases. After this approach, the final results were: total extraction 98.88%, partial extraction 0.90%, unextracted 0.15%, and not applicable 0.07%. Major complications occurred in 4 cases (0.3%) and were cardiac tamponade (2 underwent successful pericardiocentesis, 1 surgical repair, and 1 patient died). No complications were directly related to the jugular approach. In conclusion, transvenous lead extraction is an effective and safe procedure. The success rate and the incidence of complications are highly affected by the staff experience. The use of the jugular approach, in the presence of free-floating or difficult exposed leads, increases both safety and success rate.