Current practice in transvenous lead extraction in Latin America: Latin American Heart Rhythm Association survey

Abstract

Background Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead‐related complications. Currently, objective data on TLE in Latin America is lacking. Objective To describe the current practice standards in Latin American centers performing TLE. Methods An online survey was sent through the mailing list of the Latin American Heart Rhythm Society. Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for 1 month, after which no more answers were accepted. Results A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27.1% from Brazil), with most respondents (82%) being electrophysiologists. Twenty‐nine institutions (66%) performed <10 lead extractions/year, with 7 (16%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (66%) and only 13% reported the use of laser sheaths. Management of infected leads was performed according to current guidelines. Conclusion This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long‐term success are needed.

Feasibility and safety of a transvenous lead extraction program implementation in South America: Challenges, early outcomes, and global collaboration—A single-center experience

“…There is a significant lack of data on lead extraction in South America, and the results of our small series seem to be in accordance with previous reports in this region, with infections being the most frequent reason for removal and the use of mechanical tools being the preferred technique. 6 , 7 , 8 , 9 Notably, no patients had any lead malfunction as an indication for lead removal. There are many reasons for this observation, including underdiagnosis due to challenges with patient follow-up because many patients returned to their community hospitals, where further resource scarcity may lead to missed diagnoses of lead malfunctions.…”

“…However, according to a recent lead extraction survey by the Latin-America Heart Rhythm Society, the technique is not widely available, most likely secondary to high costs, lower operator experience, and/or lack of proper training/knowledge in the techniques necessary to ensure the performance of safe and effective procedures. 6 …”