Lead implant duration does not always predict ease of extraction: extraction sheath may be required at < 1 year.

INTRODUCTION

Lead implant duration is a predictor of extraction sheath (ES) use in transvenous lead extraction (TLE). Most operators agree that leads with short implant durations can be extracted easily but data regarding defibrillator (implantable cardioverter-defibrillator [ICD]) leads and newer generation leads with backfilled coils are limited.

METHODS AND RESULTS

We performed a retrospective study of consecutive patients undergoing TLE of leads with implant durations of ≤ 2 years at a single, high-volume center. Patient and lead characteristics, indications, and ES use were analyzed. Between January 2000 and January 2011, 139 patients underwent TLE meeting inclusion criteria. Mean implant duration was 13.2 ± 6.4 months. The cohort was 67% male with a mean age of 63 years (16-93) and left ventricular ejection fraction of 36 ± 17%. Indications for extraction included infection (51%), lead malfunction (27%), device upgrade (13%), and other indications (venous occlusion, severe chronic pain at site of device or lead, advisory leads, etc., 9%). Extraction was achieved with simple traction alone in 68% of the 239 leads removed. ES assistance with laser or femoral sheaths was employed in 32% of cases. ES use increased significantly with longer implant duration (P = 0.0004). In multivariate analysis, young age, the presence of an ICD, and increasing implant duration were the strongest predictors of the need for ES assistance for successful lead removal. There was no statistically significant difference in ES use between older and newer generation ICD leads (P = 0.68).

CONCLUSIONS

While leads with short implant durations may be extracted easily, the need for ES assistance is significant and frequently unpredictable even with newer generation ICD leads. Thus, operators should be fully prepared to use all available methods of extraction in every case regardless of implant duration.