Transvenous removal of pacing and ICD leads: a 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: From January 1997 to December 2021, we managed 2925 consecutive patients (2220 men, mean age 65.3 years) with 5370 leads (mean dwell time 74.0 months, range 1-576). PL were 4209 (1903 ventricular, 1801 atrial, 505 coronary sinus leads), DL were 1161 (1140 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 78% (systemic 27%, local 51%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and, if necessary, other intravascular tools; we performed an approach through the Internal Jugular Vein (JA) in case of free-floating leads or failure of the standard approach. Results: We attempted removal in 5359 leads because the technique was not applicable in 11 PL. Among these, 5223 leads were completely removed (97.4%), 51 (1.0%) were partially removed, 85 (1.6%) were not removed. Among 5271 exposed leads: manual traction removed 879 (16.7%) leads; mechanical dilatation using the venous entry site removed 3860 (73.2%) leads; femoral approach (FA) removed 50 (0.9%) leads; and JA removed 346 (6.6%) leads. All the free-floating leads were completely removed, 26.1% by FA and 73.9% by JA. Major complications occurred in 23 cases (0.78%): cardiac tamponade (21 cases, 5 deaths), hemothorax (2 cases, 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.