Abstract 18180: Predictors of Extraction Sheath Assistance for Chronically Indwelling Endovascular Leads
Introduction: Recently implanted pace-sense and defibrillator (ICD) leads are typically removable via gentle manual traction. Clinical predictors of the need for dedicated extraction sheaths (ES) (use of laser or mechanical cutting sheaths) during removal of pace-sense or ICD leads have not been well defined.
Methods: A retrospective, single-center analysis was performed on all patients referred for lead extraction between 2010 and 2014. Baseline and lead characteristics were included in a multivariate logistic regression model assessing the need for ES during the procedure.
Results: A total of 170 patients (255 leads) were included in this analysis. ES was required for 75% of all leads. No lead implanted for less than 6 months required ES. Time since lead implantation and ICD lead type were significantly associated with need for ES (OR 1.03 per 30 days, 95% CI 1.02-1.05, and OR 5.22, 95% CI 2.00-13.93, respectively). When analyzed independently, ICD leads with longer dwell time and younger patient age were associated with increased risk of requiring ES (OR 1.04 per 30 days, 95% CI 1.02-1.07, and OR 0.69 per 5 years, 95% CI 0.49-0.92, respectively). For pace-sense leads, the need for ES was significantly associated with lead dwell time (OR 1.03 per 30 days, 95% CI 1.01-1.05). Patient age did not significantly influence the need for ES with pace-sense leads (p=0.76).
Conclusion: ICD and pace-sense leads implanted less than 6 months prior to removal are likely to be safely extracted with manual traction. ICD leads implanted in younger patients and with longer dwell time were significantly associated with increased risk of ES requirement, while increased need for ES for pace-sense leads was only affected by lead dwell time.
Author Disclosures: S.P. Swearingen: None. R. Kipp: None. M. Tattersall: None. D. Kopp: None. M. Leal: None.
- © 2016 by American Heart Association, Inc.