Transvenous lead extraction: clinical failure and complications in patients with or without abandoned lead

Introduction Increasing cardiac implantable electronic device (CIED) implantations, patient comorbidities and longer life expectancy contribute to an increased need for transvenous lead extraction (TLE). The management of redundant or malfunctioning leads remains controversial, with little data available to guide management. An increasing number of TLE procedure are carried with this indication, so a better knowledge of safety and efficacy in this setting is needed. Purpose The aim of this study is to evaluate the efficacy and the safety of TLE in patients with abandoned leads in order to have a better risk stratification. Methods All patients who underwent TLE in our center from January 2009 to December 2017 were included and retrospectively analyzed. Clinical data, device features and procedural outcome and complications were collected. The primary endpoint was the clinical success of the procedure. Logistic regression was performed to identify predictive factors for clinical success. Results We analyzed 1210 consecutive patients that required transvenous removal of 2343 leads. The group of patients with one or more abandoned leads counted 250 patients (21%) with 617 abandoned leads (26%). The number of leads was higher in patients with abandoned leads (3.0 vs 2.0; P<0.001) and the dwell time of the oldest lead was significantly older in this group (108.00 months vs 60.00 months; P<0.001).Clinical success was achieved in 1168 patients (96.5%) with a lower rate in the group of patients with abandoned leads (90.4% vs 98.1%; P<0.001). Major complications occurred in only 13 patients (1.0%) without significant differences among the two groups (abandoned leads 1.2%, without abandoned leads 0.8%, P=0.58). Logistic regression analysis demonstrated that the presence of abandoned leads was an independent predictor of lower clinical success (OR: 0.267, 95% CI: 0.0.100-0.711; P=0.008). Patients with a dwell time of the oldest lead lower than 107 months had a higher rate of clinical success (OR: 11.80, 95% CI: 3.88-35.81; P<0.001), whereas we didn’t find a significant correlation between the number of leads and the risk of clinical unsuccess. Conclusions Transvenous lead extraction is associated with a high success rate and few serious procedural complications. The presence of abandoned leads and a high dwell time of the oldest lead are independent predictors of clinical unsuccess, whereas a higher number of leads didn’t affect the outcome. The rate of major complications was not affected by the presence of abandoned lead, probably due to the extremely low incidence of this event.