Transvenous removal of pacing and ICD leads: single Italian referral center experience

Abstract

Abstract Introduction Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center. Methods From January 1997 to December 2021, we managed 2925 consecutive patients (2220 men, mean age 65.3 years) with 5370 leads (mean dwell time 74.0 months, range 1–576). PL were 4209 (1903 ventricular, 1801 atrial, 505 coronary sinus leads), DL were 1161 (1140 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 78% (systemic 27%, local 51%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and, if necessary, other intravascular tools; we performed an approach through the Internal Jugular Vein (JA) in case of free-floating leads or failure of the standard approach. Results We attempted removal in 5359 leads because the technique was not applicable in 11 PL. Among these, 5223 leads were completely removed (97.4%), 51 (1.0%) were partially removed, 85 (1.6%) were not removed. Among 5271 exposed leads: manual traction removed 879 (16.7%) leads; mechanical dilatation using the venous entry site removed 3860 (73.2%) leads; femoral approach (FA) removed 50 (0.9%) leads; and JA removed 346 (6.6%) leads. All the free-floating leads were completely removed, 26.1% by FA and 73.9% by JA. Major complications occurred in 23 cases (0.78%): cardiac tamponade (21 cases, 5 deaths), hemothorax (2 cases, 1 death). Conclusions Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads. Funding Acknowledgement Type of funding sources: None.