Impact of fixation mechanism and helix retraction status on right ventricular lead extraction.

BACKGROUND

The impact of lead fixation mechanism on extractability is poorly characterized.

OBJECTIVE

We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads.

METHODS

A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0-9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups.

RESULTS

Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted < .01) and the passive fixation group (adjusted < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis ( = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%.

CONCLUSION

TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.