Experience with transvenous lead extraction of His bundle pacing leads

Background: Nowadays, we observe a growing interest in conduction system pacing (CSP).Therefore, we expect the number of patients with CSP to increase significantly in the coming years.However, there is a lack of large data on transvenous lead extraction (TLE) procedures of CSP leads, particularly HBP leads in the adult population.Aims: Study aims to present experience of performing TLE procedures in patients with CSP leads utilizing a non-stylet driven Medtronic 3830 lead in two tertiary lead extraction centers in Poland.Methods: A prospective analysis of the records consisted of all patients with HBP leads who underwent TLE from October 2011 to November 2023.Results: The study involved 38 patients, with a median (Q1-Q3) age of 69.7 (65.6-76.0)years, 8 of whom were female (21.1%).The median (Q1-Q3) lead dwell time was 15.5 (8.7-19.8)months, Thirty leads were removed using simple traction, while eight leads required mechanical extraction tools.All leads with lead dwell time over 42 months required mechanical extraction tools.The median (Q1-Q3) fluoroscopy time was 1.03 (0.07-11.5) min.There were no intra-procedural major or minor procedural complications.The radiological and clinical success was achieved in 100% of targeted CSP leads. Conclusion:TLE from the His bundle and left bundle branch region is safe and effective procedure, with no lasting damage to the His-Purkinje system.Successful re-implantation of the lead in the His-Purkinje conduction system is possible in the majority cases.