BackgroundCardiovascular implantable electronic device (CIED) associated infection is the most common indication for lead extraction. While the need for complete device removal is well established, this study is the first to examine the impact of antimicrobial duration on clinical outcomes.Figure 1:Overall Survival Post-CIED Lead Extraction Stratified by Duration of Antibiotic TherapyMethodsWe reviewed all patients who underwent CIED lead extraction at our institution between June 2013 and December 2023. Patients who had extraction for a primary indication of bacteremia or lead-associated vegetation were included. Duration of antibiotics prescribed was stratified by initial decision to treat, ≤ 2 weeks or > 2 weeks post-extraction. Measured outcomes were all-cause mortality at 90 days, rates of recurrence or relapse of bacteremia from the same organism, infectious complications, and post-operative disposition to intensive care unit (ICU).ResultsOf 747 patients reviewed, 79 cases met inclusion criteria. Baseline characteristics were very similar between cohorts. Median duration of antibiotic therapy was 12.6 and 38.6 days, respectively. Kaplan-Meier survival analysis showed no significant difference in survival (p= 0.438, HR 0.693, 95% CI 0.085-5.652). There was no difference in rates of recurrent bacteremia (7% vs 6%, p=0.952), infectious complications (27% vs 30%, p=0.817), hospital length of stay (mean 9.9 vs 13.3, p=0.360), post-operative ICU disposition (0% vs 17%, p=0.112), and rates of cardiac arrest (7% vs 5%, p=0.577) between patients who were prescribed ≤ 2 weeks of antibiotics versus > 2 weeks of antibiotics, respectively. Relapse or recurrence was seen in 5 patients, all of whom had Staphylococcus aureus (n=3) or Serratia sp. (n=2) and either an LVAD or valve replacement.ConclusionShorter durations (≤ 2 weeks) of antimicrobial therapy after CEID lead extraction was not associated with increased mortality or higher rate of recurrent bacteremia. Among the few patients that experienced relapse or recurrence in both groups, all were associated with high-risk organisms for secondary seeding of other cardiovascular prostheses. Larger studies are needed to define optimal antibiotic duration and determine risk factors for recurrent bacteremia in this population.DisclosuresAll Authors: No reported disclosures

Venous thrombosis occurring after TLE procedures is a fairly common but poorly described complication and requires further investigation into its causes. The aim of this study was to identify independent predictors of UEDVT occurrence after TLE procedures. We analyzed data from 504 transvenous lead extraction procedures performed in the hybrid surgery room of the Department of Electrocardiology and Heart Failure at the Medical University of Silesia, Katowice, Poland, between January 2016 and May 2022. All procedures were performed using mechanical-only techniques. In the analyzed period, as a result of 504 transvenous extraction procedures of cardiac implantable electronic device leads, 19 (3.8%) cases of symptomatic venous thrombosis of the upper extremity on the side of the procedure occurred. The mean age of patients who developed the complication was 65.8 ± 13.3 years, and 68.4% were men, which did not differ significantly from the general group. Based on variables selected in the univariate analysis, a logistic regression model of risk factors for UEDVT was calculated. These include a history of cancer disease in patients (p = 0.0110), heart failure according to the Class IV NYHA scale (p = 0.0397), advanced longest dwell time (p = 0.0323), extraction of atrial lead (p = 0.0368), and the use of mechanical non-powered telescopic sheaths (p = 0.0455). As protective factors were assessed, infectious indications for TLE (p = 0.0288) and the highest platelet concentration (p = 0.0448). Thrombosis is a relatively rare but serious complication. The precise selection of patients at risk of thrombosis after TLE may increase clinical success. It has been shown that an increased risk of thrombosis after TLE occurs in patients with a history of cancer, with heart failure in NYHA Class IV, and platelet concentration is low, in whom TLE is performed for noninfectious reasons, with the use of additional equipment like mechanical non-powered telescopic sheaths.

Management of Lead-Related Superior Vena Cava Syndrome: Clinical and Procedural Outcomes.

Closed-loop extraction of precious metals from e-waste via NH4HCO3 desulfurization and secondary lead smelting.

Late Dislodgement of a Residual Functional Atrial Lead Four Years after Ventricular Lead Extraction: A Case Report

Misplacement of pacemakers lead into the left ventricle (LV) is a rare but clinically important complication, often facilitated by unrecognized intracardiac shunts such as a patent foramen ovale (PFO). Early recognition is essential to avoid systemic embolization and ensure safe device function. We report a man in his 70s with a background of bioprosthetic aortic valve replacement, coronary bypass grafting, hypertension, chronic kidney disease, Parkinson′s disease, and prostate cancer, who underwent permanent pacemaker implantation for symptomatic sinus pauses. Follow‐up echocardiography 1 year later, performed as part of surveillance of his aortic valve prosthesis, unexpectedly revealed that the ventricular lead had crossed a PFO and was positioned in the LV via the mitral valve. His 12‐lead ECG demonstrated a right bundle branch block‐like paced morphology, raising suspicion of LV pacing. The patient remained asymptomatic with no evidence of systemic embolization. He was anticoagulated with apixaban and subsequently underwent successful lead extraction and repositioning into the right ventricle (RV). Correct RV placement was confirmed using multiple fluoroscopic views, particularly the left anterior oblique (LAO) projection and by postprocedure ECG, chest x‐ray, and echocardiogram. This case underlines the importance of careful assessment of paced ECG morphology, fluoroscopic views during implantation (especially LAO), and postimplant imaging to confirm lead location. Suspicion should be raised when an RBBB‐like QRS morphology is observed during RV pacing. Timely recognition and management with anticoagulation, followed by extraction and repositioning, can prevent potentially devastating complications. Operators should remain vigilant for inadvertent LV lead placement, particularly in patients with unrecognized PFO. Routine use of multiple fluoroscopic projections and correlation with ECG and echocardiography can aid early diagnosis and improve procedural safety.

Percutaneous Mechanical Aspiration: A Game Changer for Infective Endocarditis?

Hybrid open chest transvenous lead extraction (TLE), combining surgical and endovascular techniques, may be utilized in patients requiring concomitant cardiac surgery or with high-risk features for endovascular extraction. Outcome data in this population remains sparse. To evaluate procedural outcomes and identify predictors of complications in patients undergoing elective hybrid open chest TLE. A retrospective multicenter cohort study was conducted, including 40 patients between 2017 and 2025 across three UK tertiary centers. Patients undergoing emergency surgical conversion were excluded. Baseline, procedural, and outcome data were collected. Primary outcomes were in-hospital mortality and complications, graded using a modified Delphi classification. Logistic regression was used to identify predictors of any or severe (Delphi grade ≥3) complications. The mean age was 61.9±17 years; 62.5% were male. Median lead dwell time was 10.5 years. The indication was infection in 65% of cases. Concomitant valve intervention was performed in 77.5% of cases. Clinical procedural success was 97.5%. In-hospital mortality was 2.5%, with a rate of severe complications of 15%, and an overall complication rate of 37.5%. Multivariable analysis identified chronic lung disease as an independent predictor of severe complications (OR 102.2, p=0.03). Atrial fibrillation was an independent predictor of any complication (OR 5.83, p=0.04), driven primarily by post-procedure rhythm intervention. Lead dwell time and EROS classification were not associated with adverse outcomes. Hybrid open chest TLE demonstrates high procedural success and despite significant morbidity, has acceptable mortality rates. Chronic lung disease independently predicts complications and should guide patient selection and perioperative planning.

Patients with end-stage renal disease (ESRD) on hemodialysis are at increased risk for bacteremia, which may necessitate transvenous lead extraction (TLE) if a cardiac implantable electronic device (CIED) is present. Most data on outcomes of TLE in ESRD come from small, single-center studies. The National Inpatient Sample database was analyzed to identify hospitalizations where patients underwent TLE between 2016 and 2021. Baseline demographics, comorbidities, and outcomes were stratified by history of ESRD. We identified 98 115 weighted hospitalizations where patients underwent TLE, of which 5005 (5%) had a history of ESRD. Patients with ESRD were younger and had a higher prevalence of comorbidities including congestive heart failure, diabetes, hypertension, and liver dysfunction. Compared to those without ESRD, in-hospital mortality was significantly higher in patients with ESRD undergoing TLE (10.4% vs. 2.5%, p < 0.001). The incidence of vascular complications (including superior vena cava perforation) and cardiogenic shock was also higher in patients with ESRD, as was the length of stay and total hospitalization cost. Even after adjustment for baseline differences, in-hospital mortality after TLE remained significantly higher in patients with ESRD (adjusted odds ratio [ORs] 2.1, 95% confidence interval 1.6-2.7). In a nationally representative cohort, unadjusted in-hospital mortality among patients with ESRD undergoing TLE is over 10%, and even after adjustment for covariates, patients with ESRD were more than twice as likely to die in the hospital compared to non-ESRD patients undergoing TLE. The increased availability of CIEDs without transvenous hardware may mitigate some of the long-term burden of device implantation in patients with ESRD.

This article examines a methodology for the rehabilitation of accumulated environmental damage sites (AEDS), based on the conversion of disturbed and contaminated lands into potentially fertile soils using bulk waste (overburden, decontaminated soils, drill cuttings, oil-contaminated soils, and landfill soils) in combination with various technological methods, including thermal decontamination, leaching, and treatment with humic preparations and natural adsorbents. The main conceptual principles of this methodology are based on a combination of organizational and technical techniques (methods). These techniques enable the conversion of disturbed and contaminated lands into potentially fertile soils, and the conversion of waste into secondary raw materials. The objective of this study was to develop a concept for the rehabilitation of AEDS based on the conversion of disturbed and contaminated lands, as well as waste, into potentially fertile soil (PFS) using an innovative technology that takes into account the particle size distribution, chemical contamination, cation exchange capacity, humus content, and the safety (hazard class 5) of the resulting substrate. The technology for producing conditionally fertile soils was examined using the example of a model problem of converting inert coarse waste of hazard class 5 into potentially fertile soil suitable for reclamation. The experimental studies showed that drill cuttings, a large-tonnage industrial waste, are of particular interest as an ameliorant. The resulting complex composition of humic-mineral ameliorant and sand meets the requirements for PFS, as drill cuttings provided 10% of the fine fraction, the humic preparation met the humification standard, and together, the humic preparation and drill cuttings provided a sufficient cation exchange capacity of the soil – 17 mg-eq/100 g. Changes in soil phytotoxicity were studied depending on the reclamation dose and time. A sharp reduction in phytotoxicity was achieved with a reclamation dose of 0.8 kg/m2. Samples of man-made soil with initial lead, zinc, and copper contents were studied. The extraction of lead, copper, and zinc by dynamic leaching ranged from 80 to 95%, demonstrating the potential of the proposed soil remediation method.

Transvenous lead extraction (TLE) is used in various clinical scenarios, such as device-related infections. Mechanically powered sheaths are one of the most commonly used tools for TLE procedures. We evaluated the procedural and clinical outcomes of a novel extraction technique for chronically implanted leads in the treatment of device-related infections. The novel extraction technique utilizing standard implantation stylets, snares, reused rotational sheaths, catheters, and wires was evaluated for procedural success and clinical outcomes. A total of 12 consecutive patients with device-related infections underwent the novel TLE procedure. Complete procedural success was achieved in all patients, with a minor complication rate of 8% (one patient). No major complications or procedure-related mortality were observed. During a median follow-up period of 435 days, one patient died due to a multidrug-resistant systemic infection, one due to end-stage heart failure, and one underwent valve surgery for concomitant valve endocarditis. No cases of reinfection were reported in the study population. Additionally, this novel technique was approximately 85% less costly than the conventional standard technique using locking stylets and unused rotational sheaths. In situations where unused extraction tools are unavailable or limited by reimbursement constraints, this novel TLE technique offers an effective and safe alternative.

A Challenging Case of Transvenous Lead Extraction Using a Mechanical Dilator Sheath via Combined Subclavian and Femoral Vein Approaches.

The need for transvenous lead extraction (TLE) is rising due to increased cardiovascular device implantation and an aging population. While the superior access is standard, complex cases may benefit from the Tandem approach, combining femoral and superior access to improve efficacy and safety. This study evaluates outcomes and predictors associated with the Tandem approach as a primary strategy. A retrospective analysis was conducted on 148 patients who underwent Tandem TLE at a high-volume UK center between September 2020 and December 2024. Data on procedural success, complete lead removal, complications, and outcome predictors were collected. The Needle's eye snare (NES) learning curve was assessed via fluoroscopy time. Median patient age was 72.4 years, with 42.6% considered high-risk (EROS 3). 319 leads were targeted, with 81.2% extracted via the Tandem approach. Clinical procedural success was 97.3%, and complete lead removal 93%. Use of Medtronic leads was the sole independent predictor of complete lead removal. Major complications occurred in 3.4% of cases, with no procedural mortality. BMI < 25 kg/m² and extraction of ≥ 3 leads were predictors of complications and 30-day mortality. NES proficiency improved significantly after 40 leads (p < 0.001), confirming a learning curve. The Tandem approach is a safe and effective primary strategy for complex TLE, particularly in cases involving passive fixation, shock, and long dwell times leads. However, widespread use may be limited by resource intensity, increased fluoroscopy exposure, and the need for experienced operators.

ABSTRACTBackgroundThe increasing use of cardiac implantable electronic devices (CIEDs) has led to a rise in transvenous lead extractions (TLE), particularly for device‐related infections. The elderly represent a growing subgroup undergoing TLE, but data on their outcomes are limited.ObjectivesTo evaluate the safety and in‐hospital outcomes of TLE in patients aged ≥ 80 years with device‐related infections.MethodsWe analyzed the National Inpatient Sample (NIS) from 2016 to 2020 to identify hospitalizations involving TLE for device‐related infections. Patients were stratified by age: < 80 years and ≥ 80 years. The primary outcome was in‐hospital mortality. Secondary outcomes included major procedural complications and length of stay. Multivariate logistic regression identified independent predictors of in‐hospital mortality and complications.ResultsAmong 30 670 patients who underwent TLE, 6530 (21.3%) were aged ≥ 80 years. In‐hospital mortality did not differ significantly between groups (4.0% vs. 4.6%, p = 0.40), nor did overall complication rates (6.7% vs. 6.9%, p = 0.81). However, elderly patients had higher rates of post‐procedural stroke (0.3% vs. 0.02%, p = 0.002) and bleeding (1.6% vs. 0.8%, p = 0.04). Independent predictors of mortality included chronic kidney disease (aOR 2.2, 95% CI: 1.2–4.2), cirrhosis (aOR 12.2, 95% CI: 1.1–133), and respiratory failure (aOR 50.7, 95% CI: 6–425). Elderly patients were more frequently discharged to rehabilitation facilities (40.3% vs. 25.5%, p < 0.001).ConclusionElderly patients undergoing TLE for infections had similar in‐hospital mortality and complication rates compared to younger patients. Age alone should not preclude TLE. However, increased risks of stroke and bleeding warrant targeted perioperative assessment. Further studies are needed to assess long‐term outcomes in this population.

Pacing catheter-induced right ventricular (RV) perforation is a rare, life-threatening complication. Its surgical procedure typically involves lead extraction and perforation site repair via a median sternotomy. Recently, a minimally invasive approach via a minithoracotomy has been the alternative feasible approach to cardiac surgery; it reportedly prevents sternotomy-related morbidities or offers favorable cosmetic results. Herein, we present two cases in which a temporary pacing catheter-induced RV perforation was repaired via left minithoractomy. CASE 1: An 84-year-old female was admitted with a complete atrioventricular block, which was then treated by temporary pacing catheterization. Two days later, the pacing failed. Computed tomography and echocardiography revealed that the temporary pacing catheter migrated and penetrated the RV apex without pericardial effusion. Subsequently, we repaired the perforation via a left minithoracotomy through the left sixth intercostal space. Intraoperatively, a hematoma was detected on the RV apex, with the penetrated catheter covered by the epicardium. After removing the pacing catheter, we achieved hemostasis by using sheet-type hemostatic agents. CASE 2: A 91-year-old female developed a complete atrioventricular block following transcatheter aortic valve implantation. She then underwent temporary pacing catheterization. Two days postoperatively, the pacing failed because the catheter was dislocated, as confirmed by chest X-ray. Computed tomography also revealed RV perforation apparently. Meanwhile, the fixing sutures of the pacing catheter were loose. She then underwent RV repair via a left minithoracotomy in the same fashion as that of case 1. The pacing catheter perforated the RV apex apparently, with bloody pericardial effusion. After removing the pacing catheter percutaneously, we repaired the perforation site through mattress suturing. Two patients with RV perforation caused by temporary pacing catheterization with stable hemodynamics were successfully treated by a left minithoracotomy.

Transvenous lead extraction (TLE) is procedurally complex and carries significant risk. Evidence on optimal TLE techniques is limited and lacks comparative studies. PubMed, Embase, Cochrane Library, and Web of Science were searched through November 27, 2024. We included randomized clinical trials (RCTs) or non-randomized controlled trials (non-RCTs) comparing two or more TLE methods in adults undergoing lead extraction. A network meta-analysis was conducted to estimate pooled outcomes with 95% CIs. P-scores ranked treatments. Eleven non-RCTs and one RCT were included. No statistically significant differences were observed in patient-level clinical success or lead-level procedural success. The femoral approach was associated with a significantly lower risk of significant complications compared to the use of laser sheaths (odds ratio, 0.28; 95% CI, 0.09-0.89). Rotating mechanical sheaths (RMS) ranked highest for clinical (p=0.7470) and procedural success (p=0.7357), while the femoral approach ranked highest for safety (p=0.8368). Laser sheaths ranked lowest across all outcomes. No single technique was superior in terms of success rates. RMS and the femoral approach had the highest rankings for efficacy and safety, respectively. Laser sheaths ranked lowest for both. Rigorous prospective studies with direct comparative analyses are required to establish evidence-based protocols and improve TLE patient outcomes.

The "No-cut technique" for lead preparation in transvenous lead extraction.

Assessment of lead and alkali metal ions extraction from crystal glass cups after prolonged contact with daily beverages

Role of the Bridge balloon in improving the safety of transvenous lead extraction procedures.

Transvenous lead extraction should be performed in the electrophysiology laboratory.