PO-633-06 SAFETY AND EFFICACY OF TRANSVENOUS LEAD EXTRACTION IN PATIENTS WITH VERY LONG LEAD DWELL TIME

Abstract

Tranvenous lead extraction (TLE) is an important component of lead management in patients with cardiac devices. Lead dwell time has been associated with increased procedural complexity and is often associated with a perception of increased risk. There is, however, limited data on the safety and outcomes of TLE in patients with leads of very long dwell times. Describe safety and outcomes of TLE in patients with leads with a very long (>= 20 years) dwell time. Patients undergoing TLE between 2013 - 2021 with at least one targeted lead with 20 years or more dwell time were identified from a single center prospective registry. Patient characteristics, outcomes, and 30-day major adverse events were collected. Clinical success of TLE was defined as the removal of all targeted leads and all lead material from the vascular space with less than 4 cm lead fragment residual that does not negatively impact either the patient or procedural goals. Lead-level analysis was summarized as number (percentage) for categorical variables and as mean ± standard deviation for continuous variables. Major adverse events related to TLE procedure, in accordance with HRS guidelines, within thirty days of the procedure were recorded. A total of 36 patients were included in the analysis with 71 leads of >= 20 years dwell time targeted for extraction. Mean patient age was 60.4 years (± 15.1) with the majority of patients having ≥2 indwelling leads. Included patients were predominantly male (64%) and Caucasian (86%). Indications included infection (25%), lead malfunction (32%); other indications including vascular occlusion and system revision made up the remaining 45% of cases. Among the 71 targeted leads, 94% were pacing leads and the mean dwell time was 25 years (±4.9 years). Initial applied tool was TightRail in 62% of cases and a laser sheath in 37% of cases. A femoral approach was ultimately required in 11% of cases. Clinical success was achieved in 90% of patients. There was one major adverse event, specifically vascular laceration requiring emergent sternotomy for repair. Leads with a very long (>=20 year) dwell time can be safely and successfully targeted for extraction. Further data from larger multicenter cohorts is needed to help guide optimal extraction strategies and patient selection.