Lead extraction of very old leads using the PISA technique - experience of a portuguese tertiary care center

Abstract

Abstract Background The "Pisa Technique" (PT) is an increasingly used method of lead extraction (LE) that is associated with the lowest rate of complications reported in the ELECTRa Registry. Lead dwell time has been recognized as the highest risk factor for extraction failure and procedure-related complications. Purpose To investigate the safety and efficacy of LE, using the PISA technique, of very old cardiac implantable electronic devices (CIED) leads. Methods Patients submitted to LE of very old leads (with an implant duration of more than 10 years) between February 2013 and October 2022 (Old group), were compared with a contemporary cohort of patients subjected to LE of leads with a shorter implant duration (New group). The PT was used in all patients. Demographic, clinical, and patient-related variables, complications, mortality, and reimplantation data were assessed. Results A total of 150 very old leads were removed from 86 patients in the Old group, and a total of 305 leads were removed from 171 patients in the New group during the study period. Regarding the baseline characteristics, patient mean age was 69.5±16.9 years, 82.6% were male. Nine patients (10.5%) had cardiac resynchronization devices, 11 (12.8%) implantable cardioverter-defibrillator devices, and 66 (76.4%) pacemaker systems (mostly DDD). Of the total LE in the Old group, 88.4% were due to CIED infection (44.1% with valvular or lead endocarditis) vs 75.9% (p=0.464) vs the New group. The mean "age" of the extracted leads was 163.7±53.4 vs 46.6±34.9 months, and there were more of active fixation in the New group 35.2% vs 58.9%, p<0.01. A previous attempt of LE had been done in 5.8% vs 11.1% (p=0.172) of the patients, there were more previous generator replacements in the Old group 67.4% vs 23.7% (p<0.01). The radiographic success rate of the attempted lead extractions was similar between both groups 90.7% vs 96.5% (p=0.063). The clinical success rate was slightly lower in the Old group 95.3% vs 99.4% (p=0.031). The procedure major complications rate in the Old group was 2.3% (there were 2 cases of cardiac tamponade that required sternotomy with no laceration of the SVC observed) vs 1.2% (p=0.294) in the New group. Minor complications occurred in 11.6% vs 8.8% (p=0.466) of the LE (mostly comprised of infected pocket hematomas). No deaths occurred during the procedures, and there was no extraction-related mortality in both groups. Conclusion Our center’s experience with the PISA technique confirms the method’s safety and feasibility for the percutaneous extraction of very old CIED leads.