Outcomes of transvenous lead extraction in patients with lead perforation: A single-center experience.

Abstract

BackgroundManagement of cardiac perforation caused by the lead of a cardiac implantable electronic device (CIED) is currently unclear. This study evaluated the outcomes of transvenous lead extraction (TLE) in patients with cardiac perforation caused by a transvenous lead.HypothesisRemoval of perforated lead by transvenous approach is safe and effective.MethodsThe medical records of all patients diagnosed with cardiac perforation by a pacing or defibrillator lead in Peking University People's Hospital from January 2008 to January 2019 were reviewed. We included patients who were managed by TLE.ResultsA total of 53 patients (30 men; mean age: 67 ± 15 years) with lead perforation managed by TLE were included. Most of the perforated leads (94.9%) were pacemaker leads. Forty‐three leads (81.1%) were implanted within 1 year. Ten patients with a high risk of hemopericardium underwent percutaneous subxiphoid pericardial puncture prior to TLE. All 53 culprit leads were removed completely without major complications. Simple traction with or without a locking stylet was sufficient in 51 patients (96.2%). Forty‐eight patients (90.6%) had a new active‐fixation lead reimplanted. No patients showed evidence of new‐onset or worsening pericardial effusion during the procedure and hospital stay. During a median follow‐up time of 16 months, no recurrence of symptoms associated with lead perforation or CIED‐related infection were reported.ConclusionIn most patients with lead perforation, TLE can be a safe and effective management approach.