Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996

Charles L. Byrd, Bruce L. Wilkoff, Charles J. Love, T. Duncan Sellers, Kyong T. Turk, Russell Reeves, Raymond Young, Barry Crevey, Steven P. Kutalek, Roger Freedman, Richard Friedman, Joey Trantham, Michael Watts, John Schutzman, Jess Oren, John Wilson, Frank Gold, Neal E. Fearnot, Heidi J. Van Zandt

Research output: Contribution to journalArticlepeer-review

Abstract

Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix® or Encor® leads (46%), or other causes (2%). Patients were 64 ± 17 years of age (range 5- 96); 59% were men, 41% women. Leads were implanted 47 ± 41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P < 0.0001), less experienced physicians (P < 0.0001), ventricular leads (P < 0.005), noninfected patients (P < 0.0005), and younger patients (P < 0.0001). Major complications were reported for 1.4% of patients (< 1% at centers with > 300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P < 0.005) and with less experienced physicians (P < 0.005); risk of major complications was higher for women (P < 0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.

Original languageEnglish (US)
Pages (from-to)1348-1357
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume22
Issue number9
DOIs
StatePublished - Oct 26 1999
Externally publishedYes

Keywords

  • Infection
  • Lead extraction
  • Lead removal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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