Introduction: It is observed recently rise necessity for transvenous lead extraction (TLE). TLE with conventional technique using mechanical systems, is counted as safer but less effective and more laborious technique.
Objectives: analysis of the effectiveness & safety of mechanical systems for TLE.
Methods: we have extracted 2197 ingrown (PM >12, ICD >6 mths) leads in 1295 pts. (61,6% M) mean age 64.4y, with PM and ICD systems. 73,2% leads were PM-BP, 10,1% - PM – UP and 14,8% ICD –% and 2,0% consisted VDD PM leads. 67,0% - passive fixation and 33,0 – active fixation. 35,6% were RA (RAA, BB), 6,5% LA (CS, CSO), 54,3% RV (RVA, RVOT), 3,5%, LV vein and 0,3% LA or LV (erroneous placement). Mean dwelling time was 82,4 mths. In 42,8% of pts. 2 leads were explanted, in 44,8% - single and in the remaining 12,5 % - 3 (max. 6) leads. The most common (57,0%) indications for TLE were non-infective; local pocket infection and endocarditis and the were less frequent (25,8% & 17,2%).
Results: Aver. procedure time was 110,2 min. (30-420). Lead venous entry approach was used for most (83,8%) of leads; femoral approach were used for free floating leads and combined - (including jugular approach) for extraction of broken leads - in 1,8% and 2,2% respectively. Simple extorsion and traction was utilized in 11,7% for active fixation leads. Full radiol. success: 94,6%; remained tip only 2,3%, led fragment (<4 cm) 2,5% and only 8 leads were left due to high risk of tricuspid valve damage. Clinical success: 98,1%. Major complications appeared in 18 cases (1,39%): 9 hemopericardium (surgery), 4 hemopericardium (drainage) and 1 pleuropericardium (drainage), 1 pleuropericardium (surgary), 1 pulmonary embolism 1 severe hypotonia and 1 cerebral stroke. Minor complications were more frequent (1,7%): pulmonary embolism (3), hemothorax (3), hemopericardium (6) tricuspid regurgitation (4), subclavian vein thrombosis (2) but problems were solved without invasive intervention. 5 procedure related deaths were noted. Technical complications (prolonging procedure, forced to change venous approach and utilize additional technique and tools) happened in 210 (16,2%) cases.
Conclusions: 1. TLE in experienced centre is very effective (nearly 95%) even in cases very old (>20 y) and dual-coil ICD leads 2. In experienced centre it is safe procedure (0,3% of death); major complications are infrequent (1,4%) 3. TLE may to need numerous complementary techniques; disposement of alternative techniques are necessary to completion procedure of 4% procedures 4. Cardio-surgery stand-by is necessary (was utilized in 10/1295 procedures).