Po-02-079 safety and feasibility of device extraction of the his 3830 selectsecure© lead

The 3830 SelectSecure© Lead (Medtronic, MN) is widely used for conduction system pacing. Data regarding the safety and complexity of lead extraction from the septum with this lumenless 4.1 Fr ETFE coated lead is limited to a few reports. To evaluate safety, efficacy, and complexity of 3830 lead extractions implanted on the interventricular septum. Consecutive patients undergoing SelectSecure© lead extractions between Jan 2015 and Jan 2021 at Virginia Commonwealth University were analyzed. Procedural tools, lead dwell times, complications, and indications for lead failure were tabulated. A total of 23 patients had lead extractions during the study period. All leads were implanted in the His bundle region with median dwell time of 190 days (IQR 34-319 days) and mean dwell time of 290 days. Devices were implanted for sick sinus syndrome (13, 57%), AV block (9, 39%), and planned CRT (1, 4%) The most common indication for extraction was lead failure (75%) followed by device upgrade (17%), infection (4%), or a combination of need for upgrade with lead failure (4%). The mean capture threshold prior to extraction was 2.8V±1.9V @ 1 ms. 21 (91%) of patients had successful explant with manual traction alone, 2 (4%) leads required laser sheath, and 1 (4%) patient required both laser and mechanical tools. The only complication was a femoral vein hematoma; total lead extraction with no remnants, was achieved in all patients. Procedural success was complete and safety outcomes were excellent with the caveat that the cohort primarily fell into the low to intermediate risk category, as calculated by the SAFeTY TLE score. The dwell times are relatively short given the more recent advent of the technique. Device extraction of the entirety of the 3830 lead can be done safely despite its placement in the septum and a unique lumenless design. However, most extractions took place after relatively short implant times and more information is needed about extraction of 3830 after long implant times.