Transvenous removal of pacing and ICD leads: 15 years experience from a referral center

Abstract

Introduction: Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center. Methods: Since January 1997 to December 2012, we managed 1958 consecutive patients (1489 men, mean age 65.6 years) with 3539 leads (mean pacing period 70.7 months, range 1-420). PL were 2936 (1457 ventricular, 1207 atrial, 272 coronary sinus leads), DL were 603 (582 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 83% (systemic 27%, local 56%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique (Cook Vascular - Leechburg PA, USA) and if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach. Results: Removal was attempted in 3531 leads because the technique was not applicable in 8 PL. Among these, 3463 leads were completely removed (98.1%), 35 (1%) partially removed, 33 (0.9%) not removed. Among 3449 exposed leads, 532 were removed by manual traction (15.4%), 2586 by mechanical dilatation using the venous entry site (75.0%), 25 by femoral approach (FA) (0.7%) and 238 by JA (7%). All the free-floating leads were completely removed, 25.6% by FA and 74.4% by JA. Major complications occurred in 12 cases (0.6%): cardiac tamponade (11 cases, 2 deaths), hemotorax (1 death). Conclusions: Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.