A 15-year experience with permanent pacemaker and defibrillator lead and patch extractions.

BACKGROUND

The value of extraction of infected or hazardous epicardial and endocardial pacemaker and internal cardioverter defibrillator (ICD) leads is well established. Recent reviews including all leads and patches are lacking. This review describes experience with open and percutaneous techniques, including all lead types and indications.

METHODS

With Institutional Review Board approval, we reviewed charts of all adults and children undergoing extraction of permanent pacemaker and ICD leads and patches by a single operator between 1993 and 2008.

RESULTS

Overall, 145 leads and 7 patches were removed from 79 patients. Dwell time averaged 56.2 months. The commonest indications for extraction were infection (73.4%) or risk of lead fracture (20.3%). Most leads (84.2%) were extracted percutaneously. Removal was complete for 131 leads (86.2%) and partial in 14. Incomplete lead removal was rarely associated with clinical complications. Minor complications occurred in 6 patients (7.6%) and major complications occurred in 3 (3.8%). The major complication rate was 16.7% for the open group and 1.5% in the percutaneous group.

CONCLUSIONS

Pacemaker and ICD infections generally respond to antibiotics, complete hardware removal, and a hardware free interval. However, these principles cannot always be invoked, and the risk of complications is likely to increase when hardware cannot be completely removed or when a hardware-free interval is unsafe or inadvisable. Percutaneous lead extraction is superior to open extraction in terms of safety and comfort, but epicardial extraction techniques remain critically important in selected patients.