Transvenous laser lead extraction in patients with congenital complete heart block

Darden, Douglas; Boateng, Bendelyn Asante; Tseng, Andrew; Alshawabkeh, Laith; Pollema, Travis; Cha, Yong‐Mei; Birgersdotter‐Green, Ulrika

doi:10.1016/j.hrthm.2022.02.031

Cited by 5 publications

(13 citation statements)

References 19 publications

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“…Due to the increase of life expectancy in patients with CIED, limited lead longevity, and intentional abandonment of inactive leads accepted by HRS/EHRA guidelines [ 12 , 13 , 14 ], the number of patients with old (>20 years) and very old (>30 years) leads increases. This was confirmed by previous observations by other authors [ 1 , 29 , 30 ] and our current analyses, which showed that the rate of removal of leads older than twenty years almost doubles with successive five-year periods (3–6–10%).…”

Section: Discussionsupporting

confidence: 93%

“…Our analysis of 223 TLE showed that our patient population with 20- and 30-year-old leads is specific: young or middle-aged in good general health, more female, usually with pacemakers and multiple system-related risk factors (multiple/abandoned leads, many previous procedures) meaning an accumulation of risk factors for MC of TLE. A higher percentage of women and more abandoned leads have been reported by other authors [ 1 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 49%

“…Our knowledge of >20 years old lead extraction is based on 3 reports (186 patients in total) [ 1 , 29 , 30 ] and several case presentations [ 31 , 32 , 33 ]. Although previous reports have indicated that “TLE of old (≥20 years) leads can be performed with reasonable success and safety when conducted at centers with expertise in lead management” [ 29 ], the risk of old and very old leads extraction is overestimated in general opinion.…”

Section: Discussionmentioning

confidence: 99%

“…There is a growing population of patients with CIEDs (cardiac implantable electronic devices) with a long or very long-life expectancy [ 1 , 2 , 3 , 4 ]. The limited, yet extending the average duration of intracardiac leads functionality (pacemaker—PM—about 20 years, implantable cardioverter-defibrillator—ICD—about 10 years) [ 3 , 4 , 5 , 6 , 7 ] and changes in the health status of patients requiring device upgrade [ 8 , 9 ] result in the abandonment of inactive or redundant intracardiac leads [ 10 , 11 ], which is accepted by successive editions of guidelines on cardiac implantable devices [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The authors of the abovementioned reports did not analyze in detail the effectiveness and safety of transvenous lead extraction of leads older than 20 and 30 years [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. To the best of our knowledge, there are only two studies assessing the outcomes of lead extraction older than 30 years in 124 and 43 patients [ 29 , 30 ] and in a population of 16 young patients with an average age of removed lead close to 20 years [ 1 ]. In addition, the number of cases-reports regarding the removal of older leads was published [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Kutarski

Główniak

Kosior

et al. 2022

IJERPH

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Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.

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