Key result
Right-sided TLE linked to ~2-fold higher odds of SVC or RA tear.
Why the study?
Outcomes of transvenous lead extraction for systems implanted on the right chest remained underexplored because of their low incidence, leaving uncertainty about whether system laterality influences procedural outcomes.
Does a right-sided approach influence procedural efficacy and safety outcomes compared to a left-sided approach in patients undergoing transvenous lead extraction?
Cohort (n=4,989)
No
Does a right-sided approach influence procedural efficacy and safety outcomes compared to a left-sided approach in patients undergoing transvenous lead extraction?
Right-sided transvenous lead extraction carries a significantly higher risk of major vascular injury and sternotomy, along with lower complete extraction rates compared to left-sided extraction, warranting careful consideration during both device implantation and extraction planning.
Answers are grounded in this paper and cite their sources.
Right-sided TLE increases procedural complexity from bilateral systems and lead factors; leaves open independent laterality effects on success or complications.
BACKGROUND: Despite extensive experience with transvenous lead extraction (TLE) overall, outcomes for systems implanted on the right chest remain underexplored, largely because of their low incidence. OBJECTIVES: The objective was to evaluate whether system laterality influences TLE outcomes. METHODS: Using our institutional, prospectively maintained ExTRACT registry, we analyzed all consecutive patients undergoing TLE procedures at the Cleveland Clinic between 1996 and 2022. Patients were categorized by system laterality. Baseline characteristics, procedural characteristics, and complications were assessed. Multivariable logistic regression models evaluated the association between right-sided TLE and adverse events. RESULTS: Among 4,989 patients, 494 (9.9%) had right-sided and 4,495 (90.1%) had left-sided TLE. Compared with left-sided cases, right-sided cases had longer total lead dwell times (13.83 vs 9.26 years, P < 0.001) and were more likely to be extracted because of infection (47.57% vs 39.71%, P = 0.001). Fluoroscopy time was longer (15.95 vs 12.1 minutes; P < 0.001), and femoral workstation use more frequent (7.89% vs 4.05%, P < 0.001), yet complete extraction was lower (94.53% vs 96.44%, P = 0.034). Right-sided TLE had higher rates of sternotomy (2.83% vs 1.25%, P = 0.004) and superior vena cava or right atrial tear/perforation (2.49% vs 1.10%, P = 0.009). Thirty-day mortality was low and comparable (0.61% vs 0.47%, P = 0.727). Multivariable regression showed that right-sided TLE was associated with higher odds of sternotomy (OR = 1.92, 95% CI: 1.01-3.46, P = 0.037) and superior vena cava or right atrial tear/perforation (OR = 2.02, 95% CI: 1.01-3.78, P = 0.037). CONCLUSIONS: Right-sided TLE is associated with a lower rate of complete extraction and increased procedural risk, particularly sternotomy and major vascular injury, compared with left-sided TLE. These findings should be carefully weighed when implanting or extracting right-sided systems.
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Demian et al. (2026) conducted a cohort in Transvenous lead extraction (n=4,989). Right-sided transvenous lead extraction vs. Left-sided transvenous lead extraction was evaluated on Superior vena cava or right atrial tear/perforation (OR 2.02, 95% CI 1.01-3.78, p=0.037). Right-sided transvenous lead extraction had lower complete extraction and higher odds of SVC/RA tear and sternotomy.
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