Key result
Transvenous lead extraction of leads with a dwell time ≥20 years achieved a clinical success rate of 95.6%, compared to 99.2% for leads with a dwell time <20 years (p=0.017).
Why the study?
Lead dwell time is a recognized risk factor for extraction failure and complications during transvenous lead extraction, prompting evaluation of safety and effectiveness for leads dwelling 20 years or longer.
Is transvenous lead extraction safe and effective in patients with pacemaker or ICD leads older than 20 years compared to younger leads?
Observational (n=124)
No
Is transvenous lead extraction safe and effective in patients with pacemaker or ICD leads older than 20 years compared to younger leads?
Absolute Event Rate: 95.6% vs 99.2%
p-value: p=0.017
Transvenous lead extraction of pacemaker or ICD leads older than 20 years can be performed with high clinical success (96%) and acceptable safety at experienced centers, despite slightly lower success rates compared to younger leads.
Supports extraction feasibility for leads ≥20 years at experienced centers; extends observational data but leaves open need for prospective validation.
BACKGROUND: In patients undergoing transvenous lead extraction (TLE), lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications. OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of TLE in patients with pacemaker or ICD leads with a dwell time of ≥20 years. METHODS: This is a single-center retrospective study of all patients who underwent TLE of at least 1 pacemaker or ICD leads a dwell time of ≥20 years. RESULTS: During the study period, 124 patients were included in this analysis (50.8% female, mean age: 74.6 ± 10.7 years). Device-related infection was the most common (92.7%) indication for TLE. Extraction was attempted for a total 313 leads, of which 182 leads had dwell times ≥20 years (median: 276 months; interquartile range: 255-300 months). Complete procedural success was achieved in 112/124 patients (90.3%), and clinical success in 119/124 patients (96.0%). Complete removal was achieved for 294 leads (93.9%), partial removal in 10 leads, and failure in 9 leads. Clinical success (combined complete and partial success) rates were higher for leads with dwell times <20 years compared to older leads (99.2% vs. 95.6%, p = .017). Major procedural complications (including 1 death) occurred in 7/124 patients (5.6%). Minor complications were observed in 8 patients (6.5%). CONCLUSIONS: TLE of very old (≥20 years) leads can be performed with reasonable success and safety when conducted at centers with expertise in lead management.
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Ziad F. Issa (2021) conducted an observational in Pacemaker or ICD leads requiring transvenous lead extraction (n=124). Lead dwell time ≥20 years vs. Lead dwell time <20 years was evaluated on Clinical success (combined complete and partial success) (p=0.017). Transvenous lead extraction of leads with a dwell time ≥20 years achieved a clinical success rate of 95.6%, compared to 99.2% for leads with a dwell time <20 years (p=0.017).
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