Difficulty and Complications of Lead Extraction-Is ICD Lead Design Important?

Transvenous removal of implantable cardioverter-defibrillator (ICD) leads is considered to be more difficult and risky. The goal was to explore the impact of ICD lead design on transvenous lead extraction (TLE) safety and effectiveness.

Analysis of 3929 TLE procedures (including 1068 with ICD lead extraction) were analyzed retrospectively.

The extracted ICD leads were about three years younger than pacemaker (PM) leads (medians: 61.00 vs. 97.00 months). The rate of major TLE complications (MC) was significantly higher in the PM lead extraction group (2.25% vs. 0.75%; p = 0.002) and complete procedural success was achieved significantly less often (by 4.11%; p < 0.001 in entire group of patients and by 3.74%; p < 0.001 in patients matched according to age of extracted lead). However, no significant differences were found in the scores of TLE complexity and major complications during extraction of ICD leads produced by different manufacturers. Lower rates of complete procedural success, compared to Medtronic ICD leads, were found in patients with Abbott and Biotronik ICD leads (99.45% vs. 97.32%; p = 0.009 and 96.65%; p = 0.003).

1. ICD lead implant duration was 3.17 years shorter and perhaps for this reason ICD lead extraction was often less difficult, the procedure less complex and MC significantly rare (0.75%) in comparison with PM lead extraction (2.55%). There were no differences between groups matched according to age of extracted lead. Achieving of complete procedural success was lower in PM lead extraction both in entire as in matched group of patients. 2. There were no significant differences in the complexity of TLE procedures or the incidence of major complications depending on ICD lead manufacturer, despite the fact that Biotronik leads were 16-19 months older. 3. The extraction of Abbot and Biotronik leads was associated with a lower rate of complete procedural success (by 2.13% and 2.80%).