Transvenous laser lead extraction in patients with congenital complete heart block
Douglas Darden1, Bendelyn Asante Boateng1, Andrew S Tseng2
1Division of Cardiovascular Medicine, University of California San Diego, San Diego, California.
Insights
Transvenous lead extraction (TLE) in congenital complete heart block (CCHB) patients is complex, with high lead malfunction rates. Experienced centers are crucial due to potential major complications during TLE procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Pediatric Cardiology
Background:
- Limited data exists on managing cardiac implantable electronic device leads in congenital complete heart block (CCHB) patients.
- CCHB patients often undergo multiple device interventions, including generator changes and lead revisions, at a young age.
Purpose of the Study:
- To describe the natural history and outcomes of transvenous lead extraction (TLE) in patients with CCHB.
- To evaluate the safety and efficacy of TLE procedures in this unique patient population.
Main Methods:
- Retrospective registry data from two institutions (2011-2021) were analyzed for all attempted TLE procedures in CCHB patients.
- Patient demographics, device history, indications for TLE, procedural details, complications, and follow-up outcomes were collected.
Main Results:
- 16 CCHB patients (mean age at implant 13.8 years) underwent TLE after an average of 19.2 years of lead dwelling time.
- Lead malfunction (69%) and infection (31%) were primary TLE indications. Complete procedural success was 87.5%, with two major complications (12.5%).
- All patients survived at 1-year follow-up, despite significant lead revisions and abandoned leads in the cohort's history.
Conclusions:
- CCHB patients present unique challenges for lead management, including frequent interventions and long lead dwell times.
- Transvenous lead extraction in CCHB patients carries a risk of major complications, underscoring the need for experienced centers.
- Further research with larger cohorts is necessary to validate these findings and optimize TLE strategies in CCHB.
Background:
Data on lead management in patients with congenital complete heart block (CCHB) with cardiac implantable electronic devices are lacking.
Objective:
The purpose of this study was to describe the natural history and outcomes in patients with CCHB with cardiac implantable electronic devices undergoing transvenous lead extraction (TLE).
Methods:
Data on all attempted TLE procedures in patients with CCHB at 2 institutions between 2011 and 2021 were collected from a retrospective registry.
Results:
Overall, 16 patients (mean age at transvenous device implant 13.8 ± 4.7 years) were included. Before TLE, patients underwent an average of 2.25 ± 1.3 generator changes, 3 (19%) underwent cardiac resynchronization therapy upgrade, and 7 (44%) underwent a lead revision with subsequently abandoned leads. Mean patient age at TLE was 34.4 ± 9.4 years with a mean duration of lead implant of 19.2 ± 6.9 years. Lead malfunction (n = 11 [69%]) and infection (n = 5 [31%]) were the most common indications for TLE. A total of 38 leads were removed, with complete procedural success achieved in 14 of 16 (87.5%). Two (12.5%) major complications occurred, including right ventricular laceration and superior vena cava tear requiring sternotomies. All patients survived at 1-year follow-up.
Conclusion:
Patients with CCHB represent a unique cohort highlighted by several generator changes, lead revisions, and abandoned leads at a young age, along with a long duration of lead dwelling time and a high prevalence of lead malfunction requiring TLE. There may be a high risk of major complications during TLE, suggesting TLE should be performed only in experienced centers. Larger studies are needed to confirm these findings.
