Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients?

Abstract

Background: Lead management in children and young adults is still a matter of debate. Methods: To assess the course of transvenous lead extraction (TLE) in adults with pacemakers implanted in childhood (CIP) we compared 98 CIP patients with a control group consisting of adults with pacemakers implanted in adulthood (AIP). Results: CIP patients differed from AIP patients with respect to indications for TLE and pacing history. CIP patients were four–eight times more likely to require second-line or advanced tools. Furthermore, CIP patients more often than AIP were prone to developing complications: major complications (MC) (any) 2.6 times; hemopericardium 3.2 times; severe tricuspid valve damage 4.4 times; need for rescue cardiac surgery 3.7 times. The rate of procedural success was 11% lower because of 4.8 times more common lead remnants and 3.1 times more frequent permanently disabling complications. Conclusions: Due to system-related risk factors TLE in CIP patients is more difficult and complex. TLE in CIP is associated with an increased risk of MC and incomplete lead removal. A conservative strategy of lead management, acceptable in very old patients seems to be less suitable in CIP because it creates a subpopulation of patients at high risk of major complications during TLE in the future.

Transvenous Lead Extraction in a European Low-Volume Center without On-Site Surgical Support

“…The technique we used was first described by Bongiorni MG et al, reporting high success rates and safety using simple extraction tools [50]. The most common indication for TLE in our study was device-related infection (74%), like reports regarding TLE and device infections in the EU and US [51,52]. We started using this approach in 2018 and have become a referral center for TLE.…”

Practical Approaches to Transvenous Lead Extraction Procedures—Clinical Case Series

“…Due to organizational problems and economic issues, TLE centers use a different approach in the application of safety requirements; in some centers, the TLE procedure is performed in an electrophysiology, catheterization, or laboratory room, with deep analgesiasedation, while in other centers, TLE is performed in an operating room/hybrid room, with general anesthesia and additional monitoring of the procedure (transesophageal echocar-diography and arterial line), in the presence of a cardiac surgeon [10,11]. Transesophageal echocardiography, when used as a monitoring tool during TLE, was observed to provide higher rates of complete procedural success and a reduced risk of major complications [12].…”