Permanent Transvenous Lead Extraction: Factors Influencing the Difficulty of the Procedure

Transvenous lead extraction is increasingly required. The aim of this study was to determine which factors influence the difficulty of a lead extraction procedure through the analysis of a high-volume centre database. A total of 889 permanent leads were extracted from 469 patients. Factors influencing the difficulty of a procedure were assessed using a multivariate logistic regression model. The fluoroscopy time of the procedure was taken as index of difficulty. From January 2003 to December 2012 , 932 of 946 (98.5%) leads were completely removed. Major complications occurred in 1.3% patients. No deaths occurred. Median fluoro time was 8.4 min (3.2 - 17.1). A procedure was classified as difficult when fluoro time was greater then 31.2 min (90th percentile). At a multivariate analysis the predictors of a difficult procedure were the number of extracted leads (OR 1.71, 95%CI 1.06 – 2.8), the presence of screw leads (OR 5.68; 95%CI 1.9 – 16.9), the presence of dual coil shock leads (OR 5.01, 95%CI 1.27 – 19.8), the years since the oldest lead was implanted (OR 1.23, 95%CI 1.15 – 1.31), the absence of leads with vegetation (OR 6.76, 95%CI 1.35 – 33.3). The female gender, the patient age at extraction, the presence of tachy leads, the presence of lead failure weren’t predictors of a difficult procedure. Factors influencing the difficulty of an extraction procedure are the number of leads, the presence of screw leads, the presence of dual-coil tachy leads, the years since the oldest lead was implanted and the absence of leads with vegetation.