Abstract 2907: Transvenous Pacemaker and Defibrillator Lead Extraction in the Setting of Noninfectious Indications: A Large, Single Center Experience
Extraction of infected pacemaker and defibrillator leads has become standard of care with the development of safe techniques. However, controversy remains over the safety and efficacy of extraction in patients without device infection. The goal of this study was to review a large, single center experience with transvenous lead extraction in patients without concomitant infection.
METHODS: A retrospective review of 1,854 ICD and pacemaker lead extractions performed at the Cleveland Clinic between 8/1996 and 7/2006. Analysis identified 623 extraction procedures performed in 588 patients for noninfectious indications. Procedures were reviewed for indication, success and complication rates, and patient mortality.
RESULTS: Primary indication for the extraction(%, n): lead fracture (51.8,323), lead malfunction (20.9,130), venous occlusion (6.4,40), removal for device upgrade (5.5,34), extracardiac position (2.9,18), lead recall (2.2,14), surgically damaged leads(2.1,13), lead malposition (1.6,10), lead dislodgement (1.1,27), high DFTs (1,6), failed prior attempt (0.6,4), pain from lead stimulation (0.5,3), and lead stuck in a device header (0.2,1). Complete extraction was accomplished in 951 (95.5%) of 996 leads, clinical success in 617 (99.0%) of 623 procedures, and extraction related mortality occurred in 2 pts (0.3%). Complication and mortality data are presented below:
CONCLUSION: Tranvenous lead extraction for non-infectious indications can be effectively accomplished with high success rates and low morbidity and mortality. The long term value of this procedure should be evaluated in relationship to both the risks and effectiveness of the intervention.