Percutaneous extraction of endocardial leads--a single centre experience in 120 patients

The expanding number of patients treated with pacing, especially resynchronisation therapy and pacing system upgrades as well as leads remaining inactive, and prolonged life expectancy are the causes of an increase of the number of electrodes in pacemaker patients. The growing problem with endocardial lead infections and excess leads has made percutaneous lead removal technology widespread as it is less invasive than cardiosurgery.

We present our experience in percutaneous lead removal in a single reference centre in Poland.

During 2.5 years, 236 leads in 120 patients were removed. The criterion for inclusion in the present analysis was the age of the oldest lead: > 12 months in pacemaker patients and > 6 months in patients with implantable cardioverter-defibrillators (ICD). All patients admitted to the hospital for lead removal underwent a percutaneous procedure. The age of the patients ranged from 18 to 87 (mean 65.7) years. The leads were removed using the Lead Extraction System (Cook) with the rotational cutting force only, notlaser or RF energy.

Indications for lead removal were: local (pocket) infection (47%), endocarditis (27%) and lead excess (26%). Seventy six percent of patients had at least two pacemaker/ICD-related procedures whereas 24% had only one implantation procedure in the past. The median time from the preceding procedure was 12 months. In 38 patients there were 60 inactive electrodes. The majority of patients had two (62%) or three (19%) leads, followed by 12% with one lead and 7% of patients with more than three leads. In 27.5% of patients leads from the coronary sinus were removed. The complication rate was 4%.

Percutaneous lead removal procedures are performed in Poland for class I and II indications according to NASPE classification. In many cases patients had multiple leads, including in the coronary sinus. The majority of patients had two or more interventions in the past.