Abstract
Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.
Highlights
Transvenous lead extraction (TLE) is an integral part of the lead management strategy [1,2,3,4,5]
The echocardiographic variables considered for the analysis included left ventricular ejection fraction (LVEF), the degree of tricuspid valve (TV) dysfunction before and after TLE, mean right ventricular systolic pressure (RVSP), the presence of fibrotic scarring, lead thickening, lead-to-lead binding, lead adherence to any heart structure and right ventricular wall perforation by the lead
The mean left ventricular ejection fraction (LVEF) was 49.26%, renal failure occurred in 25.00% of patients, the Charlson comorbidity index was 5.10
Summary
Transvenous lead extraction (TLE) is an integral part of the lead management strategy [1,2,3,4,5]. Fibrotic scarring around the leads [6] places the patient at risk of fatal complications such as venous or cardiac injury with severe bleeding [7,8,9,10,11] or worsening tricuspid regurgitation [12,13,14,15,16,17,18]. Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their
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