PO-02-049 FIXATED ON FIXATION: UNRETRACTED HELIX IN ACTIVE FIX RV LEAD EXTRACTION PRESENTS SIMILAR CHALLENGES TO PASSIVE LEAD EXTRACTION

Abstract

The impact of lead fixation mechanism on extractability is poorly characterized. We aimed to compare the technical difficulty of transvenous lead extraction (TLE) in active versus passive fixation right ventricular (RV) leads. Four hundred and eight patients who underwent RV TLE at our high-volume center between October 2011 and June 2022 were identified from an institutional database and retrospectively analyzed. Of these, 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. A numerical system (0-9) was devised using six procedural criteria to quantify a technical extraction score (TES) for each RV lead extraction. Points were assigned accordingly: 0- Removal by manual traction 1- Locking stylet used 1- Use of a tool 2- Use of more than one size tool of the same type 2- Use of both laser and mechanical tools 3- Use of a groin tool Median age at time of extraction was 62 years, 63% of patients were male. The median dwell time for active and passive fixation leads was 5.4 and 5.6 years, respectively (p=0.1003). Within the active fixation group, the median dwell time was 4.0 years for leads with successfully retracted helices, and 7.1 years for leads with failed helix retraction. Helix retraction was successful in 55% of active fixation lead extractions. Forty-four percent of active fixation leads had an infectious extraction indication, while only 25% of passive fixation leads were extracted for infectious reasons (p=0.0038). The mean TES for active and passive TLE was 2.4 and 3.6, respectively (p<0.0001). There was no statistically significant difference in TES between patients who underwent TLE with passive fixation or active fixation with failed retraction (TES 3.5) (adj p=1.0). Overall, the lead extraction success rate was 95% in both groups (p=1.0). The rate of extraction related complications was less than 1%. Transvenous lead extraction of active fixation leads in which helical retraction is achieved presents fewer technical challenges than extraction of passive fixation RV leads; however, if the helix cannot be retracted, the active and passive leads present similar technical challenges.