Transvenous Lead Extraction in Patients with Congenital Heart Disease

Background/Objectives: A significant subset of congenital heart disease (CHD) patients undergo a transvenous pacemaker (PM)/implantable cardioverter defibrillator (ICD) lead extraction (TLE) in their lifetime. We aimed to report on the outcome and complexity of TLEs in CHD patients for whom a powered mechanical sheath was used. Methods: This retrospective study included 175 consecutive TLEs performed at our centre. Overall, 13 TLEs in CHD patients and 162 TLEs in non-CHD patients were performed. A total of 264 leads were extracted. Results: CHD patients were younger than non-CHD patients at the time of their first lead implant (21.2 ± 17 vs. 57.1 ± 18 years; p < 0.01) and at the time of lead extraction (33.38 ± 13 vs. 63.31 ± 16 years; p < 0.01). The leads extracted from CHD patients were significantly older than the leads extracted from non-CHD patients (median: 8.0 vs. 4.0 years; p < 0.01). CHD patients and non-CHD patients did not differ in terms of the procedural (92% vs. 87%; p = 0.581) and clinical success rates (100% vs. 91%; p = 0.269). The two patient groups did not differ in terms of their procedural complication rate (0% vs. 11%; p = 0.191). There were no differences in the extraction techniques used, i.e., rotational mechanical sheaths were used in 61% of CHD extractions and in 38% of non-CHD extractions; p = 0.11. Conclusions: TLEs that use rotational mechanical sheaths as an advanced technique can be safely and effectively performed in CHD patients. The outcome and complexity of TLEs in CHD patients are comparable with those in non-CHD patients that undergo this procedure.