Experience with transvenous lead extraction of His bundle pacing leads

Background: Nowadays, we observe a growing interest in conduction system pacing (CSP). Therefore, we expect the number of patients with CSP to increase significantly in the coming years. However, there is a lack of large data on transvenous lead extraction (TLE) procedures of CSP leads, particularly His bundle pacing (HBP) leads in the adult population. Aims: This study aimed to present the experience of performing TLE procedures in patients with CSP leads using a non-stylet-driven Medtronic 3830 lead in two tertiary lead extraction centers in Poland. Methods: A prospective analysis of the records involved of all patients with HBP leads who underwent TLE from October 2011 to November 2023. Results: The study involved 38 patients, at a median (interquartile range [IQR]) age of 69.7 (65.6––76.0) years, 8 of whom were female (21.1%). The median (IQR) lead dwell time was 15.5 (8.7–19.8) months. Thirty leads were removed using simple traction, while 8 leads required mechanical extraction tools. All leads with lead dwell time over 42 months required mechanical extraction tools. The median (IQR) fluoroscopy time was 1.03 (0.07–11.5) min. There were no intra-procedural major or minor complications. Radiological and clinical success was achieved in 100% of targeted CSP leads. Conclusion: TLE from the His bundle and left bundle branch region is a safe and effective procedure, with no lasting damage to the His-Purkinje system. Successful re-implantation of the lead in the His-Purkinje conduction system is possible in most cases.