Introduction: Transvenous lead extraction (TLE) of cardiac implantable devices has been established as a safe and effective practice. Despite the advancement of methods and techniques, there is still a wide variation amongst centres. We present our own experience from 10 years of TLE procedures at the University Hospital of Birmingham.
Methods: We retrospectively analysed the records from 371 patients undergoing a TLE procedure in our hospital between November 2010 and May 2020. Data was collected using our electronic database, clinical records and operation notes. The EHRA and HRS proposed definitions were adopted in our analysis. Multiple regression analysis using IBM SPSS 23 was performed to identify predictors of adverse outcomes and procedural success.
Results: Patient characteristics are summarised in Figure 1.  Mean age was 67 years with a mean BMI of 27.9. Explants accounted for 14.2 % of all cases. 20.9% of all devices extracted were defibrillators and 30.5% were Cardiac Resynchronization Therapy systems. In total, 833 leads were extracted with a mean of 2.2 leads per patient, out of which 20.5% were defibrillator leads and 12.7% left ventricular leads. 95.2% of cases were undertaken under local anaesthesia and conscious sedation. In 8.3% of procedures, the femoral approach was used in combination with or instead of a superior access. Laser powered mechanical sheaths were used in 45.8% of procedures. Complete lead removal was achieved in 93.3% of cases. The prevalence of procedure related major complications was 2.9%. The peri-procedural mortality was 0.5%, whilst in-hospital mortality was 2.9%. Use of laser sheath was more commonly associated with peri-procedural complications (OR 13.7, CI 95%, p = 0.038). Incomplete lead removal was statistically higher in cases where the femoral route was used (OR 12.2, CI 95%, p= 0.00) and in patients with higher number of leads that required extraction (OR 2.6, CI 95%, p = 0.003). There were no statistically important independent factors associated with peri-procedural or in-hospital mortality in our
case analysis.
Conclusions: The outcomes and safety of TLE practice in our centre are in keeping with international published data. Our observational findings demonstrate that lead extraction can be done safely and effectively under local anaesthesia and conscious sedation. Laser lead extraction is an efficient tool, which can be associated with an increase in peri-procedural complication, but no effect on mortality.
