Impact of fixation mechanism and helix retraction status on right ventricular lead extraction

BACKGROUND The impact of lead fixation mechanism on extract-ability is poorly characterized.OBJECTIVE We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads.METHODS A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospec-tively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0-9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups. RESULTS Helix retraction was successful in >55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-re-tracted, and passive fixation groups was 1.8, 3.5, and 3.7, respec-tively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivar-iate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%.CONCLUSION TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be re-tracted, active and passive TLE procedures present similar technical challenges.