The Japanese Lead Extraction Registry (J-LEX): Annual Report in 2024

The Japanese Heart Rhythm Society established a nationwide, mandatory, multi-center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J-LEX) in 2018. As of the end of 2024, a cumulative total of approximately 5400 cases has been registered across 140 participating centers since 2018. The registry includes all consecutive transvenous extractions, excluding surgical-only cases. The indication of TLE was an infection in 54.5%, and the guideline classification was class I in 59.8% and class IIa in 21.8%. As for non-infectious indications, TLE is performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty with radiation therapy. In 2024, the TLE procedure was attempted on patients with a median age of 71.3 years, female in 32.7%, in the hybrid operating room in 73.3%, and in a standard OR with a C-arm fluoroscope in 11.5%. The average implantation duration of the target leads was 8.5 years. Complete removal was achieved in 96.7% of the target leads, and clinical success in 97.3% of the patients. Perioperative complications were observed in 4.8% of the patients. Three patients died during a TLE operation, and 11 patients died in-hospital (cardiac death in three patients and non-cardiac death in eight patients).