Transvenous Lead Extraction Without Dedicated Surgical Back up in Low-Risk Patients

BACKGROUND: Transvenous lead extraction (TLE) is associated with major complications that could require immediate surgical rescue. These procedures are performed in an EP lab or hybrid OR with the presence of a surgical team on standby. We have designed an institutional protocol that permits performance of TLE in low-risk situations, in an EP lab without dedicated surgical back-up. OBJECTIVES: To investigate outcomes of TLE in low-risk patients METHODS: We retrospectively identified patients who underwent low-risk TLE at Emory Healthcare between 2010-23. Low-risk TLE were defined as an extraction of a pacing or ICD lead with a dwell time >= 1 and <= 5 years or a lead < 1 year that required extraction tools. RESULTS: Among 482 patients who met the criteria, the average lead age was 2.8 ± 1.2 years. The mean number of targeted leads per patient was 1.6±0.7. Extraction tools were required in 33.1% of cases. Major complications occurred in 0.83% of patients (n=4): 2 pericardial effusions requiring pericardiocentesis, 1 pneumothorax and 1 death from cardiogenic shock in an end stage heart failure patient. The patients with pericardial effusions and pneumothorax were part of a procedure that required lead revisions and the insertion of 1 or more new leads. No patients required surgical rescue. CONCLUSION: This study suggests that, in selected "low-risk" patients, TLE can be performed safely in an experienced EP lab at centers with on-site cardiac surgery but without a dedicated surgical standby team, potentially reducing resource utilization in resource-limited healthcare environments.