Abstract 132: Transvenous Lead Extraction: One Center Experience

Abstract

Introduction: Indications for cardiovascular implantable electronic devices (CIED) and implant procedures for the management of arrhythmia and heart failure continue to grow. Transvenous lead extraction (TLE) is the gold standard for treatment of CIED-related infection and lead malfunction. Operator experience and pathological issues, such as lead adhesions, can affect results and complications rates of TLE. Comparative safety and efficacy associated with TLE of implantable cardioverter-defibrillator (ICD), bi ventricular ICD (BIVICD or ICD+ LV lead) and pacemaker (PPM) leads for our center have not been characterized. Methods/Results: Retrospective chart analysis was done of 75 patients (63 males; mean age 65 + 14.8 years) using ICD-9 codes for TLE indications, techniques, results and associated complications (April 2006 to July 2013). TLE was done for ICDs 41%, BIVICD 32% and PPM 27% of the time. The most common cause (88%) of extraction was device related infection. Other causes were lead fracture, malfunction and patient request (12%). Primary prevention ICD (+/- LV lead) was the most commonly extracted device (56%) TLE due to infection was seen in patients with diabetes (DM 30%), chronic renal insufficiency (CRI 11%), end stage renal disease on hemodialysis (ESRD on HD 11%) and in patients with device and nondevice related procedures in the year prior to TLE (38%). Methicillin sensitive staphylococcus aureus was the most common organism (29%). Laser assisted TLE (31%) was required in superior vena cava (SVC) coil extraction at the SVC/atrial (70%) scar site and in lead extraction at subclavian vein (26%) scar for both right atrial and ventricular (RA/RV) leads. RA tip fragment was abandoned in scar tissue in 4 patients. Interventional radiology assisted atrial tip retrieval was done in one patient. One TLE related atrial tear was repaired by cardiac surgery. There were 5 deaths unrelated to the TLE procedure. Conclusion: Of the total 75 patients with TLE, infection was more common in patients with DM, CRI, ESRD on HD and in males. Our experience showed that primary prevention ICD (+/- LV lead) was the most commonly extracted device. In our center, TLE success rate was independent of the cause of TLE, age of the patient, and may be related to operator experience and technique.