Single centre experience of ICD lead extraction for lead dysfunction: Procedures and results

Abstract

The increase in ICD implantation has been accompanied by an increase in lead-related complications. Non-functional ICD leads extraction can be challenging with a high rate of complications. The aim of this study was to examine transvenous ICD lead extraction at the University Hospital of Grenoble-Alpes. This is a retrospective analysis of the extractions performed since May 2002, for lead dysfunction. The variables studied were extraction techniques and results. A total of 110 ICD leads were removed during 106 extraction procedures. The mean age was 61.8 ± 14.6 years and 80.2% were male. All procedures were performed in the operating room of cardiac surgery, under general anesthesia, with surgical stand-by and trans-esophageal echocardiographic monitoring. One ICD lead has been removed during the procedure in 96.2% ( n = 102) and 2 leads in 3.8% ( n = 4). These leads were double-coil in 88.2% ( n = 97) and single-coil in 11.8% ( n = 13). The extraction strategy consisted of simple traction (10%, n = 10), and in case of failure, gradual use of locking stylet (7.3%, n = 8), laser sheath (80%, n = 88) and femoral vascular approach by lasso (2.7%, n = 3). The global success rate was 97.2% ( n = 103). Complications recorded were bleeding (8.5%, n = 9) and tamponade (1.9%, n = 2). The mortality rate was 2.8% ( n = 3). All deaths were due to a vena cava injury, specifically superior vena cava in 2 cases and inferior vena cava in 1 case. Two deaths occurred during extraction and the third death after the end of the procedure. Univariate analysis has shown that lead age greater than 10 years is significantly associated with mortality (16.7% vs. 1.1%, P = 0.03). In this long-term monocentric experience, ICD lead extraction had a high success rate, but is still challenging with vena cava injury leading to death is 2.8%.