Abstract
Background: our knowledge of lead-related venous stenosis/occlusion (LRVSO) remains limited and there is still controversy regarding the risk factors for LRVSO. Venography is mandatory before transvenous lead extraction (TLE). Methods: we performed a retrospective analysis of venograms in 2909 patients (39.43% females, average age 66.90 years) who underwent TLE between 2008 and 2021 at high-volume centers. Results: the severity of LRVSO was likely to be dependent on the number of leads in the system (OR = 1.345; p = 0.003), the number of abandoned leads (OR = 1.965; p < 0.001), the presence of coronary sinus leads (OR = 1.184; p = 0.056), male gender (OR = 1.349; p = 0.003) and patient age at first CIED implantation (OR = 1.008; p = 0.021). The presence of permanent atrial fibrillation (OR = 0.666; p < 0.001) and right ventricular diastolic diameter (OR = 0.978; p = 0.006) showed an inverse correlation with the degree of LRVSO. The combined three-model multivariate analysis provided better prediction of LRSVO using the above-mentioned factors than the CHA2DS2-VASc score. Conclusions: the severity of LRVSO is probably dependent on the mechanical impact of the implanted/abandoned leads on the vein wall, therefore the study has demonstrated the central role of system-/procedure-related risk factors. The thrombotic mechanism may be less important, especially long after implantation, and for this reason the combined prediction model for LRVSO in this study was more effective than the CHA2DS2-VASc score.
Highlights
IntroductionLead-related venous obstruction (stenosis/occlusion) (LRVSO) usually remains asymptomatic (except acute/early axillary vein thrombosis) but makes it difficult or even impossible to implant a new lead or to insert port-a-cath and hemodialysis catheters [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]
Information about patient history of pacing such as: presence of abandoned leads before transvenous lead extraction (TLE), number of abandoned leads before TLE, presence of multiple abandoned leads before TLE, presence of more than 4 and 5 leads in heart before TLE, presence of two dual-coil implantable cardioverterdefibrillator (ICD) leads before TLE, three ICD leads before TLE, presence of leads on both sides of the chest before TLE, previous TLE before present TLE, history of early CIED
There is a large number of studies that describe the risk of lead-related venous stenosis/occlusion (LRVSO) [1,2,3,4,5,6,7,9,10,11,13,14,15,16,17,18,19,20], but they were performed in relatively small cohorts of patients and only some of them analyzed the system-related risk factors for venous obstruction [1,2,3,4,5,6,7,10,11,13,14,15,16,18,19,20]
Summary
Lead-related venous obstruction (stenosis/occlusion) (LRVSO) usually remains asymptomatic (except acute/early axillary vein thrombosis) but makes it difficult or even impossible to implant a new lead or to insert port-a-cath and hemodialysis catheters [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. The available studies on risk factors for LRVSO have conflicting results [1,2,3,4,5,6,7,9,10,11,13,14,15,16,17,18,19,20], but it is still reasonable to expect that the identification of modifiable patient-related, system-/lead-related and lead management-related risk factors can help reduce the incidence and severity of LRVSO
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