Abstract 10634: Out with the Old: Transvenous Extraction of Leads Older Than 15 Years

Abstract

Background: Lead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction. Objectives: To report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years. Methods: Procedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with use of mechanical rotational sheaths and femoral snares at operator discretion. Results: A total of 443 patients between 2011-2020 underwent lead extraction (707 leads) primarily for infection or device failure at our high-volume center. 40 patients with 69 leads >15 years old were included in this cohort (Table 1). Mean patient age was 53.5 +/- 18.5 years, 67.5% were male. Mean lead dwell time was 19.3 +/- 4.2 years. 35 of 40 (87.5%) patients had successful extraction of all leads (62 of 69 leads - 89.9%). The 5 patients without fully successful extractions resulted in 7 abandoned leads or lead fragments (mean lead age 19.6 +/- 2.3 years). 2 of these patients had abandoned leads (3 total) that were clinically significant. One patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 minutes of CPR but did well thereafter. There was no procedure-related mortality. Conclusions: Despite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.