Transvenous lead extraction at the University of Szeged: 10-year experience

Introduction: Cardiac implantable electronic device-related complications may require transvenous lead extraction. Data on procedure complexity and outcomes are derived from international registries. However, patient characteristics vary considerably between countries.Objective: To summarize the results of the 10-year systematic institutional extraction program and compare it with international data.Methods: We retrospectively analyzed consecutive patients undergoing extraction between 2012 and 2020. Data regarding patient characteristics, indications, techniques and outcomes of the procedures were collected and compared with the results of the largest comprehensive European registry (ELECTRa). We also examined success rates at different levels of the "stepwise approach".Results: 200 patients (65 +/- 14.3 years, 74.5% male) were included. The indication of extraction was predominantly infectious, exceeding the rate reported in ELECTRa (87.5% vs. 52.8%, p<0.001). Lead dwelling time was also longer in our study (7.8 +/- 6.2 vs. 6.4 +/- 5.4 years). The number of passive fixation leads was found to be also significantly higher (62.2% vs. 46.6%, p<0.001). One fifth of our patients had previously undergone a failed extraction attempt. A higher proportion of patients required the use of locking stylets (81.9% vs. 71.1%, p<0.001) and active extraction sheaths (71.8% vs. 27.1%, p<0.001). Major complications occurred in 4.5% and procedural death in 4 cases (2%). Procedural success was 88.2%, which is lower than the 95.7% reported in ELECTRa. In the stepwise approach analysis, cumulative clinical success rate was 24.8% with locking stylets, 74.2% with the primary active sheaths, 91.3% with advanced extraction techniques (crossover, femoral snare) and 96.6% with non-emergency cardiac surgery.Discussion and conclusion: In the last 10 years, a successful lead extraction program has been developed in our institution. Patient risk and procedure complexity far exceed those reported by international registries. To achieve optimal outcomes, the availability of diverse extraction techniques, experience as well as close educational and referral cooperation with implanting centers are essential.