The Transvenous removal of pacing and ICD leads: Single italian referral center experience.

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 2015, we managed 2389 consecutive patients (1830 men, mean age 65.3 years) with 4374 leads (mean pacing period 72.2 months, range 1-576). PL were 3514 (1656 ventricular, 1475 atrial, 383 coronary sinus leads), DL were 860 (839 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 81% (systemic 27%, local 54%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique 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 4364 leads because the technique was not applicable in 10 PL. Among these, 4270 leads were completely removed (97.8%), 45 (1.1%) partially removed, 49 (1.1%) not removed. Among 4279 exposed leads, 678 were removed by manual traction (15.8%), 3173 by mechanical dilatation using the venous entry site (74.2%), 36 by femoral approach (FA) (0.8%) and 298 by JA (7.0%). All the free-floating leads were completely removed, 25.8% by FA and 74.2% by JA. Major complications occurred in 15 cases (0.63%): cardiac tamponade (14 cases, 3 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.