Safety of transvenous mechanical lead extraction in patients with abandoned leads.

Background: The optimal management of redundant or malfunctioning leads is controversial. Objective: We aimed to evaluate the safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. Methods: We analyzed all TLE procedures performed in our center from January 2009 to December 2017. We evaluated safety and efficacy of mechanical TLE in patients with abandoned (group 1) compared to notabandoned (group 2) leads. Results: We analyzed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with 617 abandoned leads (26%). The total number of leads (3.0 vs 2.0), dwell time of the oldest lead (108.00 months vs 60.00 months) and infectious indication for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs 98.1%; P<0.001). Major complications occurred in only 9 patients (0.7 %), without significant differences among the two groups. The presence of one or more abandoned leads (OR 3.47; 95% IC: 1.07-11.19; P=0.037) and the dwell time of the oldest lead (OR 1.01 for month; 95% IC: 1.01-1.02; P<0.001) were associated with higher risk of clinical unsuccess. Conclusions: Transvenous Mechanical lead extraction is a safe procedure also in high risk settings, like patients with abandoned leads. Success rate resulted a bit lower, especially in presence of abandoned leads with a long implantation time.