Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

Abstract

Background: Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. Methods: We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. Results: The need for an upgrade was the leading indication for TLE in only 36–66% of patients. In 42.0–57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1–76.4% of patients, functional leads were retained in 20.2–31.9%, non-functional leads were left in place in 0.0–1.1%, and non-functional superfluous leads were extracted in 3.6–8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Conclusions: Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.

Transvenous Lead Extraction during Cardiac Implantable Device Upgrade: Results from the Multicenter Swiss Lead Extraction Registry

“…These success rates were also slightly higher than reported outcome data from other larger and newer registries such as ELECTRa and PROMET [ 5 , 6 ]. These favorable success rates in upgraded patients compared to a general TLE cohort are in line with previous reports by Barakat et al and Stefańczyk et al, who assessed a similar subset of patients undergoing device upgrade [ 12 , 13 ]. Regarding the high clinical success rate, it is important to note that not all leads are necessarily targeted during a TLE due to a planned upgrade and some of the intact leads may be re-used or—in case of especially difficult or risky extraction maneuvers—just be abandoned.…”

“…While some encouraging reports on TLE during upgrade procedures have been published [ 12 , 13 ], general evidence on procedural outcomes of TLE at the time of device upgrade is still scarce. In this nationwide observational registry, we report our experience with TLE during device upgrade procedures.…”