Factors associated with complexity during transvenous lead extraction and confirmation of a very-low-risk subset

ABSTRACT: Background Transvenous lead extraction/explantation (TLE) requires significant resources/coordination. Objective We sought to assess factors associated with the need for complex tools or major intraoperative complication (complexity) with TLE. Methods Single-center retrospective cohort in patients undergoing TLE between January 2010 and March 2022. Results There were 930 TLE in 868 patients (age 62.9 ± 15.8 years, 68% men, 63% ICDs, 1588 extracted leads, 29% infected). The median age of the oldest lead was 4.9 years (IQR 1.9-8.1). Complex tools were utilized for 59.9% of TLE, including the laser (37.2%), laser & mechanical sheaths (9.2%), mechanical sheath (9.1%), snare & laser/mechanical (4.2%), and snare alone (0.1%). Complete success was achieved in 892 TLE (95.9%). Complexity occurred with 59.9% of TLE (n=557). Unplanned complexity occurred in only 2/203 (1.0%) of pacemakers with the oldest lead <2 years old and ICDs with the oldest lead <1 year old. Factors independently associated with complexity included: # of ICD leads (p<.0001), combined lead age (p<.0001), # of transvenous leads (p<.001), abandoned leads (p=0.0058), age at the time of implantation (p=0.019), oldest lead age (p=0.025), and patient age at TLE (p=0.025). Major intraoperative complications occurred with 10 TLE (1.1%). No major intraoperative complications occurred with traction alone. Conclusion Factors associated with complexity included presence of an ICD, abandoned leads, patient age, and the number/age of leads. The risk for unplanned complexity is low for pacemaker leads <2 years and ICDs <1 year since implantation. This subset can be considered for TLE in the EP lab without immediate cardiac surgical backup.