Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

Andrzej Ząbek, Krzysztof Boczar, Mateusz Ulman, Katarzyna Holcman, Magdalena Kostkiewicz, Roman Pfitzner, Maciej Dębski, Robert Musiał, Jacek Lelakowski, Barbara Małecka

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Abstract

Aims: To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems.  

Methods and results: Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B.  

Conclusion: The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.
Original languageEnglish
Pages (from-to)1100-1109
Number of pages10
JournalEuropace
Volume25
Issue number3
Early online date20 Jan 2023
DOIs
Publication statusPublished - Mar 2023

Keywords

  • cardiac implantable electronic devices
  • complications
  • effectiveness
  • implantable cardioverter-defibrillator
  • lead
  • safety
  • transvenous lead extraction

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