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Broken leads with proximal endings in the cardiovascular system: serious consequences and extraction difficulties

Andrzej Kutarski1, Barbara Małecka, Andrzej Ząbek

  • 1Department of Cardiology, Medical University of Lublin, Lublin, Poland. barbara_malecka@go2.pl.

Cardiology Journal
|April 6, 2013
PubMed

Insights

Transvenous lead extraction (TLE) is effective for leads migrated into the cardiovascular system (CVS), though technically challenging. Similar effectiveness and complication rates were observed compared to leads with accessible proximal ends.

Area of Science:

  • Cardiovascular Medicine
  • Medical Device Technology

Background:

  • Transvenous lead extraction (TLE) is a critical procedure for managing implanted cardiac electronic device leads.
  • Lead migration into the cardiovascular system (CVS) presents unique challenges during TLE.

Purpose of the Study:

  • To analyze the effectiveness, technical challenges, and complications of TLE for leads with free endings migrated into the CVS.
  • To compare TLE outcomes for migrated leads versus leads with accessible proximal ends.

Main Methods:

  • Retrospective analysis of a 5-year database of 906 patients undergoing 1563 TLE procedures.
  • Comparison of TLE for leads migrated in the CVS versus leads with proximal ends in the pacemaker/implantable cardioverter-defibrillator (PM/ICD) pocket.

Main Results:

  • Lead migration occurred in 5% of TLE patients, predominantly affecting unipolar and atrial leads.
  • Migrated leads were associated with venous occlusion (64%) and required longer, more complex extraction procedures.
  • Despite challenges, over 95% of migrated leads were successfully extracted transvenously with similar effectiveness and complication rates to non-migrated leads.

Conclusions:

  • Transvenous lead extraction should be considered for all leads migrated into the CVS.
  • Extraction of migrated leads is technically more demanding than for leads with accessible proximal ends.
Abstract

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