Abstract 13072: Safety and Efficacy of Lead Extraction at Time of Device Upgrade

Abstract

Introduction: Patients with permanent pacemakers may require upgrade to ICD or CRT but there is no consensus on whether unused leads should be abandoned or extracted. Transvenous lead extraction (TLE) adds potential risk and can be complex in cases of complete venous occlusion. The safety and efficacy of TLE as a strategy to upgrade pacemakers has not been systematically explored and the impact of venous occlusion is unknown. Aims: 1) Characterize the success and safety of TLE for the indication of pacemaker upgrade to ICD or CRT 2) Assess the effect of complete venous occlusion on outcomes Methods: A total of 50 patients underwent TLE for the sole indication of pacemaker upgrade at UCSD from January 2018 to January 2023. All patients completed preoperative cardiac TLE CT. In-hospital outcomes and procedural variables were collected by chart review. Association with venous occlusion was analyzed using McNemar and t-tests. Results: All 50/50 (100%) patients had successful TLE and successful device upgrade with CRT-D in 44/50 (88%) patients and DC-ICD in 6/50 (12%) patients. No complications occurred (conversion to open extraction, injury, tamponade). Preoperative CT showed complete venous occlusion in 14/50 (28.0%) patients. Median lead extraction fluoroscopy time was 6.0 minutes (IQR: 3.7-8.5). Laser extraction was required in 48/50 patients (96%), laser sheath upsizing in 4/50 (8.0%), conversion to mechanical sheath in 7/50 (14.0%), and telescoping sheaths in 1/50 (2.0%). Venous occlusion was not associated with different baseline characteristics, TLE techniques, or fluoroscopy time (Table 1). Conclusions: TLE in combination with pacemaker upgrade had excellent procedural success. Preoperative CT identified complete venous occlusion in 28% of patients, but this was not associated with technical difficulty, procedural success, or clinical outcomes. Further studies are required to assess the long-term impact of this lead management strategy.