Large, single-center, single-operator experience with transvenous lead extraction: outcomes and changing indications

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Cardiac device implantation is growing, increasing the need for lead extraction.
• Tools, indications, and outcomes for lead extraction are evolving.

Purpose of the Study:

• To analyze current indications, outcomes, and complications of transvenous lead extraction.
• To evaluate data from a high-volume lead extraction center.

Main Methods:

• Retrospective cohort study of consecutive patients undergoing lead extraction.
• Analysis of patient and lead characteristics, indications, outcomes, and laser use.

Main Results:

• 975 leads removed from 498 patients (2000-2007); median implant duration 5.7 years.
• Indications: infection (60.3%), mechanical failure (29.3%), system upgrade (8.8%).
• Higher likelihood of laser use for leads >3.4 years old and for implantable cardioverter-defibrillator leads; 97.5% complete removal, 0.4% major complications.

Conclusions:

• Lead extraction in high-volume centers is highly successful with minimal complications.
• Infection remains the primary indication for lead extraction.
• Longer implant duration and implantable cardioverter-defibrillator leads necessitate laser assistance.