Efficacy and safety of mechanical transvenous lead extraction: median follow-up analysis and development of an experimental model for predicting survival post-extraction.

BACKGROUND: Cardiac implantable electronic device (CIED) implantation is on the rise, accompanied by an increase in its inevitable complications such as different types of CIED infections that require further therapy and potential device extraction. Ensuring efficacy and safety remains paramount in transvenous lead extraction (TLE), given the complex nature of the procedure. The purpose of this study is to assess the outcomes of relatively low-cost mechanical TLE, including mid-term clinical follow-up, and to develop a predictive model for post-TLE survival. This study included all consecutive patients admitted for TLE at two tertiary medical centers between 2016 and 2021. Baseline characteristics, TLE procedure details complications occurring during and/or after the procedure and follow-up outcomes were collected.

RESULTS: During the 5-year period, 100 consecutive patients underwent TLE. The mean age of the subjects was 61 ± 3 years. The average time from lead implantation to TLE was 69.34 ± 9.36 months, with a total of 216 leads extracted. The most common indication for TLE was infection observed in 87% of subjects with pocket infection seen in the majority (84%). Complete clinical success was achieved in 98% of patients, with major complications occurred in 5% of cases and only one case of peri-procedural death. Proposed experimental model showed that near 50% of the patients will live less than 73.29 months.

CONCLUSION: TLE demonstrated a high level of safety with low mortality and morbidity rates. Using low cost widely available mechanical tools is useful for treating CIED-related infections.