Poster Session Po3-60 to Po3-133

Introduction: Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is today a highly effective technique. The need of Transvenous Lead Removal (TLR) is currently rising due to the increasing number of device-related complications. Aim of this report is to analyze the longstanding experience performed in a single Italian Center. Methods: Since January 1997 to September 2007, 1211 patients (900 men, mean age 65.6 years, range 3-95) with 2102 leads (mean pacing period 68.9 months, range 1-336) were managed at our Center. PL were 1857 (1043 ventricular, 739 atrial, 75 coronary sinus leads), DL were 245 (231 ventricular, 2 atrial, 12 superior vena cava leads). Indications to TLR were class I in 33% and class II in 67% of the leads. We performed mechanical dilation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and, if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig- Whylen, G); a Femoral Approach (FA) or a Jugular Approach (JA) through the internal jugular vein were performed in case of free-floating or difficult exposed leads. Results: Removal was attempted in 2099 leads because the technique was not applicable in 3 PL (0.1%); 2066 leads (1821 PL, all the 245 DL) were completely removed (98.3%), 19 (0.9%) partially removed, 14 (0.7%) not removed. Among 2025 exposed leads, 290 were removed by manual traction (14.3%), 1539 by mechanical dilatation using the venous entry site (76%), 13 by FA (0.6%) and 150 by JA (7.4%). All the 74 free-floating leads were completely removed, 21.6% by FA and 78.4% by JA. Major complications occurred in 8 cases (0.66%): cardiac tamponade (7 cases, 2 deaths), hemotorax (1 death). Conclusions: Our results suggest that in widely experienced centers TLR using mechanical dilation has a high success rate and a low incidence of serious complications. The use of the JA allows a very high effectiveness and safety in case of freefloating or difficult exposed leads.