Right- versus left-sided transvenous lead extraction: Procedural complexity, complications, outcomes, and the role of bilateral procedures.

BACKGROUND

Right-sided (RS) implanted leads represent a small but clinically relevant subset of transvenous lead extraction (TLE). Anatomical differences and greater lead burden may increase procedural complexity during extraction.

OBJECTIVE

To compare procedural complexity, complications, and outcomes TLE for RS and bilateral-sided vs left-sided only (LS) implanted leads.

METHODS

We analyzed 4288 consecutive patients undergoing TLE, including 121 (2.8%) with extraction of at least 1 RS lead and 4167 with LS leads only. Within the RS cohort, 76 procedures were unilateral and 45 (37%) involved bilateral lead extraction. Patients were compared with the entire LS cohort and after 1:2 matching for lead type and age of the oldest extracted lead.

RESULTS

RS procedures were associated with greater lead burden, more abandoned leads (52% vs 12%), more prior device-related procedures, and longer lead dwell time (147 vs 102 months). Procedural complexity was higher, including longer single-lead dilatation time (18 vs 11 minutes), more frequent technical difficulties (57% vs 25%), greater use of advanced extraction tools and more frequent change of venous access (27% vs 4%). Bilateral procedures represented the most complex subgroup and were associated with lower procedural success. Major complications were more frequent in the unmatched analysis but not after matching. Clinical success and long-term survival were comparable between groups.

CONCLUSION

RS TLE is associated with increased complexity driven primarily by bilateral systems and lead-related factors, factors rather than implantation side itself, without adversely affecting clinical or long-term outcomes.