Transvenous extraction of pacing and defibrillator leads--a single-centre experience

Worldwide, the number of transvenous extractions of chronically implanted endocardial leads rapidly increases. Despite great technical progress, lead extraction remains a challenging procedure with possible life-threatening complications. We present the success and complication rate of lead extractions in the University Hospitals Leuven, and investigated a possible relationship between the use of powered sheaths and lead type, fixation, location and implantation time.

We present an observational retrospective cohort study of 157 patients admitted to the University Hospitals Leuven between January 2005 and December 2010, for the transvenous removal of a total of 259 endocardial leads.

Complete procedural success was achieved in 92% of patients (n = 144). Of all leads, 94% (n = 243) were completely extracted. Only in 5 patients (3%), lead extraction failed. Leads that could not be removed were significantly older (134.1 +/- 90.7 months vs. 73.1 +/- 61.9 months; P = 0.02). In the other 8 patients the leads were partially removed with a remaining major retained lead fragment in 2 and a minor fragment in 6 patients. Major procedural complication rate was 2.5% (n = 4). There were no procedure-related deaths. Powered sheaths were used significantly more for the extraction of defibrillator leads (51%) (vs. pacing leads (33%; P = 0.015)) and right ventricular located leads (43%) (vs. other location (28%; P = 0.011)). However, when comparing the need of powered sheaths for the extraction of right ventricular defibrillator leads vs. right ventricular pacing leads, only a trend to higher use was noticed (51 vs. 39%; P = 0.146). Powered sheath use was not related to fixation type. Leads that required the use of a powered sheath were implanted significantly longer (112 +/- 69.5 months vs. 41.7 +/- 33.7 months; P = 0.001).

Chronically implanted endocardial leads can be transvenously extracted in a high number of cases and with a low risk of procedural complications. Powered sheaths proved to be a helpful tool to extract leads that could not be removed by manual traction. Powered sheaths are necessary for leads with longer implantation duration and are more often used for the extraction of defibrillator leads.