Broken leads with proximal endings in the cardiovascular system: Serious consequences and extraction diffi culties

BACKGROUND: Retrospective analysis of effectiveness, technical problems, and complications of transvenous extraction of leads with the free endings migrated to the cardiovascular system (CVS). METHODS: A 5-year-old database of transvenous lead extraction (TLE) procedures comprising 906 patients with 1563 leads being removed was analyzed. TLE procedures of leads migrated in the CVS were compared with TLE procedures of leads with their proximal ends accessible in the pacemaker/implantable cardioverter-defibrillator (PM/ICD) pocket. RESULTS: In our material, the phenomenon of leads migration occurred in 5% of patients referred for TLE and affected most frequently unipolar and atrial leads. The presence of migrating leads was associated with local venous occlusion in 64% of patients. Removal of migrating leads required other techniques than extraction of leads with their proximal ends accessible in the PM/ICD pocket. More than 95% of migrating leads were extracted transvenously, but procedures were significantly longer. The presence of other leads made extraction of migrated leads even more complicated. Effectiveness and complication rates for removal of migrated leads and leads accessible in the PM/ICD pocket were similar. CONCLUSIONS: We postulate that every lead migrating in the CVS should be considered for TLE. However, this extraction is technically more difficult and challenging than extraction of leads accessible in the PM/ICD pocket.