Transvenous removal of pacing and implantable cardiac defibrillating leads – the experience of the first lead extraction center in Romania

Objective: The aim of the present study was to pre-sent the characteristics and success rate of device lead extraction during the first years of experience for our center.

Methods: Between October 2017 and may 2019 all lead extraction procedures were analised. Lead extraction was defined as removal beyond 1 year, or via a vascular route not utilized at implant or employing specialized equipment. Patient characteristics, strategies to remo-ve the devices, periprocedural clinical management and outcomes were noted for each case. The technique used for lead extraction was the same with that descri-bed by Bongiorni et al1 – using Byrd polipropilene sheaths (Cook medical), simple stylets and snare devi-ces – Needle Eye snare (Cook medical) or simple snare (Medtronic). No powered extraction tools were used. A total of 31 lead extraction procedures were performed. 21 patients were males, average age was 66 years (32-95), average implant age 7 years (1-26). The indications were endocarditis – 12 pts, pocket infection 12 pts, vein occlusion and lead malfunction 4 pts and other indica-tions 4 patients.

Results: Complete lead removal was achived in all in-fectious cases and procedural success was achieved in vein occlusion patients, in whom complete removal was not necessary. No procedural deaths occurred but 2 patients with endocarditis died after the extraction due to septic shock. Procedural complications included one pericardial efussion thet did not require pericardi-ocentesis and one local hematoma.

Conclusions: The procedural success rate and outco-mes confirm the effectiveness of this technique, in a center at the beginning of its experience. The number of patients was low, mainly due to lack of referral, but included also difficult cases – completely intravascular leads, very old leads, defibrillator leads and even an ac-tive fixation coronary sinus lead.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)