Deep sedation for transvenous lead extraction: a large single-centre experience.

Area of Science:

• Cardiology
• Anesthesiology
• Medical Devices

Background:

• Transvenous lead extraction (TLE) for cardiac implantable electronic devices (CIED) is increasingly common.
• The optimal anesthetic technique, general anesthesia versus deep sedation (DS), for TLE remains debated.

Purpose of the Study:

• To evaluate the feasibility and safety of using deep sedation (DS) for transvenous lead extraction procedures.
• To assess sedation-related complications and procedural outcomes in a tertiary care center.

Main Methods:

• Conducted TLE procedures in the electrophysiology (EP) laboratory using intravenous Fentanyl, Midazolam, and Propofol for DS.
• Employed a stepwise extraction approach utilizing locking stylets, dilator sheaths, and mechanical sheaths via various venous access routes.
• Collected patient characteristics and procedural data, analyzing for sedation-related complications using logistic regression.

Main Results:

• Successfully extracted 476 leads from 220 patients, with a mean lead dwelling time of 88 months.
• Reported sedation-related hypotension in 11.4% of patients and hypoxia in 2.3%, both managed without adverse outcomes.
• Observed 2.3% major intraprocedural complications with no procedure-related mortality; higher Fentanyl doses were associated with intraprocedural support.

Conclusions:

• Deep sedation (DS) is a safe and feasible anesthetic strategy for transvenous lead extraction in the EP laboratory.
• The procedure, when performed by experienced staff, is associated with high success rates.
• DS offers a viable alternative to general anesthesia for CIED lead extraction.