Procedural outcomes of transvenous lead extraction in patients with abandoned leads: experience from a large single...

With the rapid growth of cardiac implantable electronic device (CIED) implantations, lead management has become increasingly challenging. Transvenous lead extraction (TLE) is now a primary approach for addressing lead-related complications. However, data on TLE in patients with abandoned leads remain limited. This study evaluates the safety and effectiveness of TLE in patients with abandoned leads.

Consecutive patients undergoing TLE between January 2013 and January 2021 were enrolled and stratified into two groups: those with abandoned leads presence (Group 1) and those with active leads only (Group 2). The primary safety endpoint was major complications, and the effectiveness endpoint was clinical success of lead extraction. Among 1109 patients (median age 68 years; 70.7% male), 293 (26.4%) had abandoned leads (Group 1), while 816 (73.6%) did not (Group 2). A total of 2222 leads were extracted. Group 1 exhibited a higher number of leads per patient [2.0 (2.0-3.0) vs. 2.0 (2.0-2.0), P < 0.001], longer dwell time of the oldest lead [120.0 (72.0-174.0) vs. 48.0 (16.0-96.0) months, P < 0.001], a higher prevalence of CIED infection (94.9 vs. 87.4%, P < 0.001) and venous stenosis (51.5 vs. 38.8%, P = 0.001), and a higher proportion of MB scores ≥5 (45.1 vs. 15.0%, P < 0.001) and EROS 3 stratification (23.2 vs. 5.0%, P < 0.001). Clinical success was achieved in 1080 patients (97.4%), with major complications observed in 19 patients (1.7%). No significant differences were found between groups in major complication rates (2.4 vs. 1.5%, P = 0.299) or clinical success rates (96.2 vs. 97.8%, P = 0.154). Group 1 had lower manual traction success rate (8.9 vs. 37.5%, P < 0.001), required more advanced tools or multi-venous approaches (8.5 vs. 3.2%, P < 0.001), and showed higher rate of surgical extraction (3.1 vs. 1.1%, P = 0.030) and emergency thoracotomy (1.4 vs. 0.1%, P = 0.019). The dwell time of the oldest lead and number of leads removed mediated procedural risks. Multivariate analysis identified the dwell time of the oldest lead [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.08-1.21, P < 0.001] and the number of leads removed (OR 2.04, 95% CI 1.29-3.21, P = 0.002) as independent predictors of failure. Similarly, the dwell time of the oldest lead (OR 1.12, 95% CI 1.07-1.18, P < 0.001) and the number of leads removed (OR 1.54, 95% CI 1.04-2.28, P = 0.033) independently predicted complications.

Transvenous lead extraction in patients with abandoned leads is characterized by clinical feasibility and effectiveness. However, the presence of abandoned leads is associated with increased procedural complexity, necessitating more frequent utilization of advanced extraction tools. The adverse consequences provide a clinical rationale for prophylactic removal of non-functional leads.