A 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 2019, we managed 2769 consecutive patients (2100 men, mean age 65.5 years) with 5086 leads (mean pacing period 73.6 months, range 1-576). PL were 3998 (1828 ventricular, 1704 atrial, 466 coronary sinus leads), DL were 1088 (1067 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 79% (systemic 27%, local 52%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools; 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 5076 leads because the technique was not applicable in 10 PL. Among these, 4952 leads were completely removed (97.6%), 49 (1.0%) partially removed, 75 (1.4%) not removed. Among 4989 exposed leads, 818 were removed by manual traction (16.4%), 3664 by mechanical dilatation using the venous entry site (73.4%), 48 by femoral approach (FA) (1.0%) and 335 by JA (6.7%). All the free-floating leads were completely removed, 25.3% by FA and 74.7% by JA. Major complications occurred in 20 cases (0.72%): cardiac tamponade (19 cases, 4 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.