Background: The conventional route to insert cardiac implantable electronic devices (CIED) is not always possible. Devices implanted via the femoral route (F-CIED) remain an alternative option despite the advent of leadless and subcutaneous devices. However, the long-term outcomes of F-CIED, in particular complex F-CIED (implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) devices)), are not known. Furthermore, the feasibility and safety of extracting chronic femoral leads has not been reported.
Methods: All patients with F-CIED implanted between 2002-2019 at two high volume tertiary centres were included in the study. A total of 31 F-CIED (10 complex – ICD and CRT – and 21 simple – single and dual chamber pacemakers) were compared 1:3 to 93 matched controls of conventional devices implanted via superior venous access (C-CIED). Complications requiring intervention were classified as early (<30 days) and late (>30 days) following implant.
Results: Early complications were similar between F-CIED and C-CIED (6% vs 5%; p=0.85) and between complex F-CIED and simple F-CIED sub-groups (10% vs 5%; p=0.58). Late complications at 7.5 ± 4.9 years follow-up were higher with F-CIED compared to C-CIED (29% vs 11.6%; p<0.01) and greater with the complex F-CIED subgroup compared to simple F-CIED and complex C-CIED (60% vs 14% vs 7%; p<0.01). Eight of 12 late complications with F-CIED were related to the generator site including six generator erosions, one generator migration and one lead erosion. Eight femoral generators and 14 chronic leads (mean duration in situ 8.1 ± 2.1 years) were extracted without complication.
Conclusion: The early complication rate of F-CIED is similar to devices implanted by the conventional approach but there is an increased risk of late complications, particularly with complex femoral devices. Extraction of chronic femoral leads by expert operators in experienced centres is feasible and safe.
