Transvenous Lead Extraction in a European Low-Volume Center without On-Site Surgical Support.

Area of Science:

• Cardiology
• Medical Devices
• Infectious Diseases

Background:

• Cardiac implantable electronic devices (CIEDs) indications are rising, with a significant portion of device-related infections being endocarditis.
• Transvenous lead extraction (TLE) is a crucial procedure for managing CIED infections and complications.
• Various extraction tools exist, necessitating evaluation of specific methods like non-powered tools.

Purpose of the Study:

• To assess the safety and efficacy of transvenous lead extraction (TLE) utilizing exclusively non-powered extraction tools.
• To evaluate TLE outcomes in patients with device-related infections, including endocarditis.

Main Methods:

• A retrospective study of 88 patients undergoing TLE between October 2018 and July 2022, adhering to EHRA expert consensus.
• Focus on TLE performed solely with non-powered extraction tools.
• Analysis of lead characteristics (dwell time, type) and patient demographics.

Main Results:

• A 93.3% complete lead removal rate and 99% clinical success for partial extraction were achieved using non-powered tools.
• Device-related infections were the primary indication for TLE (74%), with endocarditis present in 32%.
• No procedure-related deaths or major complications occurred; minor complications were infrequent (6.8%) and self-resolving. 30-day mortality was 3.4%.

Conclusions:

• Transvenous lead extraction with non-powered tools is a safe and effective strategy for managing CIED infections and complications.
• The procedure demonstrates high success rates and a favorable safety profile, even without on-site surgical backup.
• Non-powered TLE offers a viable treatment option for complex lead extractions, including those with long dwell times and infections.