Clinical effectiveness and safety of transvenous lead extraction of very old leads
Wissam Mekary1, Neal K Bhatia1, Stacy Westerman1
1Department of Medicine, Cardiology Division-Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Background:
Transvenous lead extraction (TLE) success and safety are heavily influenced by lead dwell time.
Objective:
In this study, we aim to compare the clinical effectiveness and safety of TLE between young and old leads.
Methods:
We retrospectively identified all TLE procedures at Emory Healthcare from 2007 to 2023. Baseline patients' characteristics and procedural details were collected. The cohort was categorized based on the oldest lead dwell time in each procedure. The very long dwell time (VLDT) group included all procedures with the oldest lead dwell time, ≥15 years, whereas the control group included all procedures with the oldest lead dwell time <15 years. TLE outcomes were compared between the 2 groups.
Results:
Of the 1717 TLE procedures, 114 procedures (6.6%) included leads with dwell times ≥15 years. Patients in the VLDT group were older and had a higher number of targeted leads; 57% of TLE in the VLDT group were for infectious indications. Lead extraction procedural and clinical success were significantly lower in the VLDT group compared with the control group (75% vs 95%, 83% vs 97%, P < .001, respectively). There was a trend toward a higher major complications rate in the VLDT group compared with the control group (3.5% vs 1.3%, P = .058).
Conclusion:
TLE of VLDT leads has a lower procedural and clinical success and a higher complication rate than TLE of leads with a shorter dwell time. These results will allow electrophysiologists to quantify risks and benefits of abandoning leads at the time of lead revisions or upgrades.
