Transvenous Lead Extraction Outcomes in Europe

Study Questions:

What are the safety and outcomes of transvenous lead extraction (TRE)?

Methods:

Seventy-three European centers prospectively recruited patients undergoing TLE. The primary endpoint was TLE safety defined by predischarge major procedure-related complications including death. Secondary endpoints included clinical and radiological success and overall complication rates. Outcomes were compared between low-volume (LoV) versus high-volume (HiV) centers (LoV <30 and HiV ≥30 procedures per year).

Results:

A total of 3,510 patients underwent TLE. The primary endpoint of in-hospital procedure-related major complication rate was 1.7% including a mortality of 0.5%. Approximately two-thirds of these complications occurred during the procedure and one-third in the postoperative period. The most common procedure-related complications were those requiring pericardiocentesis, chest tube, or surgical repair (1.4%). Complete clinical success rate was 96.7%. The all-cause in-hospital major complications and deaths were significantly lower in HiV centers versus LoV centers (2.4% vs. 4.1%, p = 0.01) and 1.2% vs. 2.5%, p = 0.008), although those related to the procedure did not reach statistical significance. Radiological and clinical successes were more frequent in HiV versus LoV centers.

Conclusions:

This registry confirmed the safety and efficacy of TLE. Lead extraction was associated with a higher success rate with lower all-cause complication and mortality rates in high-volume compared with low-volume centers.

Perspective:

Cardiac perforation and thoracic vascular tears are the main immediate complications, and these complications are associated with high mortality. The risk of procedural death varies with the chronicity of the leads, type of the leads, and comorbidities. The capacity to immediately open the chest by a cardiac surgeon is required in high-risk extractions. High-volume centers had better safety and success rates. They were more likely than low-volume centers to use mechanical extraction tools and perform TLE in an operating room compared with a catheterization laboratory, although the manuscript does not specifically report on the operator’s primary specialty; thus, it is not clear how many extractions were done by electrophysiologists with surgical backup versus by thoracic surgeons themselves. Likewise, the report does not examine the impact of an individual operator’s volume on outcomes.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Imaging, Nuclear Imaging

Keywords: Arrhythmias, Cardiac, Cardiac Surgical Procedures, Chest Tubes, Comorbidity, Diagnostic Imaging, Heart Failure, Intraoperative Complications, Outcome Assessment (Health Care), Pericardiocentesis, Postoperative Complications, Radiography, Radiology


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