Transvenous Lead Extraction Without Dedicated Surgical Back up in Low-Risk Patients

Transvenous lead extraction (TLE) is associated with major complications that could require immediate surgical rescue. These procedures are performed in an EP lab or hybrid OR with the presence of a surgical team on standby. We have designed an institutional protocol that permits performance of TLE in low-risk situations, in an EP lab without dedicated surgical back-up.

To investigate outcomes of TLE in low-risk patients METHODS: We retrospectively identified patients who underwent low-risk TLE at Emory Healthcare between 2010-23. Low-risk TLE were defined as an extraction of a pacing or ICD lead with a dwell time >= 1 and <= 5 years or a lead < 1 year that required extraction tools.

Among 482 patients who met the criteria, the average lead age was 2.8 ± 1.2 years. The mean number of targeted leads per patient was 1.6±0.7. Extraction tools were required in 33.1% of cases. Major complications occurred in 0.83% of patients (n=4): 2 pericardial effusions requiring pericardiocentesis, 1 pneumothorax and 1 death from cardiogenic shock in an end stage heart failure patient. The patients with pericardial effusions and pneumothorax were part of a procedure that required lead revisions and the insertion of 1 or more new leads. No patients required surgical rescue.

This study suggests that, in selected "low-risk" patients, TLE can be performed safely in an experienced EP lab at centers with on-site cardiac surgery but without a dedicated surgical standby team, potentially reducing resource utilization in resource-limited healthcare environments.