Transvenous lead extraction: predictors of procedure complexity

Over the past decades, high-volume lead extraction centres gained broad experience in advanced transvenous lead extractions (TLE). However, access to advanced TLE techniques is limited, thus it would be beneficial to predict which extractions can be performed safely and effectively by simple procedures. We aimed to report on predictors of procedure complexity in clinically successful TLEs.

Our retrospective study included 70 infectious TLEs, of which 65 were clinically successful. TLEs were defined as simple if only simple manual traction or a locking stylet was required, and complex if a rotational mechanical sheath or a femoral snare was used.

42 patients underwent a complex procedure and 23 patients underwent a simple procedure. Overall, 129 leads were extracted. Complex procedures were characterised by longer lead dwell time (mean: 10.7±6.5 years vs 3.2±2.1 years; p<0.01), and a greater rate of passive lead extraction (50% vs 17.4%; p=0.02). In multivariate logistic regression analysis, longer lead dwell time (OR=1.69; 95% CI 1.24 to 2.30; p=0.001) was an independent predictor of procedural complexity. Among active fixation leads, the cut-off lead age for complex extractions was 4.5 years.

In the current single centre study, older lead age was the only independent predictor of procedural complexity. Based on this, the majority of infectious TLEs involving active fixation electrodes younger than 4.5 years may be safely performed even in centres where advanced TLE tools are unavailable.