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Right- versus left-sided transvenous lead extraction: Procedural complexity, complications, outcomes, and the role of

Andrzej Kutarski1, Wojciech Jacheć1, Łukasz Tułecki2

  • 12nd Department of Cardiology Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.

Heart Rhythm
|July 8, 2026
PubMed

Insights

Transvenous lead extraction (TLE) on the right side is more complex due to lead burden and bilateral systems, but outcomes remain comparable to left-sided TLE. This finding is crucial for understanding complex lead extraction procedures.

Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Procedures

Background:

  • Right-sided transvenous lead extraction (TLE) is a less common but significant subset of procedures.
  • Anatomical variations and increased lead burden on the right side can complicate extraction compared to the left side.

Purpose of the Study:

  • To compare procedural complexity, complications, and outcomes of TLE for right-sided (RS) leads versus left-sided only (LS) leads.
  • To evaluate the impact of bilateral lead involvement in RS TLE.

Main Methods:

  • Analysis of 4,288 consecutive TLE patients, with 121 (2.8%) involving RS leads.
  • Comparison of RS procedures (unilateral and bilateral) against an entire LS cohort, with 1:2 matching for lead type and age.
  • Detailed assessment of procedural parameters, technical difficulties, and complication rates.

Main Results:

  • RS procedures exhibited higher lead burden, more abandoned leads (52% vs. 12%), longer dwell times (147 vs. 102 months), and increased technical difficulties (57% vs. 25%).
  • Bilateral RS procedures were the most complex subgroup, associated with lower success rates.
  • Major complications were more frequent in unmatched analysis but similar after matching; clinical success and long-term survival were comparable.

Conclusions:

  • Right-sided TLE complexity is primarily driven by bilateral systems and lead factors, not the side of implantation.
  • Despite increased procedural challenges, right-sided TLE does not negatively impact clinical or long-term patient outcomes.
Abstract

Keywords:
Abandoned leadsBilateral lead extractionProcedural complexityRight-sided lead extractionTLE outcomesTransvenous lead extraction

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