Five‐Years Experience with Intravascular Lead Extraction

for the U.S. LEAD EXTRACTION DATABASE, for the U.S. LEAD EXTRACTION DATABASE

Research output: Contribution to journalArticlepeer-review

Abstract

From December 1988 to April 1994, the extraction of 2,195 intravascular pacing leads from 1.299 patients was attempted at 193 centers. Indications were: infection (54%, including 10% septicemia), pacemaker reoperation with removal of nonfunctional or incompatible leads (40%), and other causes (6%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, via the femoral vein using snares, retrieval baskets, and sheaths, or via both approaches. Leads had been implanted for 0.2 months to 24 years (mean 56 months). At the conclusion of the intravascular procedure, 86.8% of the leads were completely removed, 7.5% were partially removed, and 5.7% were not removed. For physicians performing their first case, 12% of leads were not removed; for physicians who had performed more than 10 cases, only 2% of leads were not removed. Of the 189 leads where extraction attempts had previously failed, 75.1% were completely removed, 14.8% were partially removed, and 10.1% were not removed. Scar tissue increased in severity with implant duration, was a complicating factor, and was the main cause of failure to remove leads. Use of the femoral approach increased with implant duration (5% of leads implanted 12 months or less, 11% of leads 13 months to 3 years, 20% of leads 4–7 years, and 31 % of leads 8–24 years), primarily because of increasingly abundant scarring and prior lead damage. Fatal and near fatal complications occurred in 2.5%. including 8 (0.6%) deaths (3 hemopericardium/tamponade, 1 hemothorax, 3 pulmonary embolus, 1 stroke). With experienced operators, appropriate precautions, and appropriate patient selection, modern techniques allow the successful extraction of up to nearly 98% of intravascular leads with a relatively low incidence of complications.

Original languageEnglish (US)
Pages (from-to)2016-2020
Number of pages5
JournalPacing and Clinical Electrophysiology
Volume17
Issue number11
DOIs
StatePublished - Nov 1994

Keywords

  • complications
  • infection
  • lead extraction
  • pacemaker lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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