Ci-452765-2 clinical predictors of incomplete cs lead removal during transvenous lead extraction in the patients with cardiac resynchronization therapy

Previous reports of coronary sinus (CS) lead removal consisted of small studies with short implant durations and suggested consistent complete removal. However, as implantation duration prolongs, the strength of the conclusions about procedural outcomes and clinical predictors for incomplete CS lead removal are questionable. To examine the safety, efficacy, necessity of powered sheath, and the clinical predictors for incomplete lead removal by Transvenous Lead Extraction (TLE) in a large, long duration, prospectively collected, observational registry of patients presenting for extraction of a cardiac resynchronization device and leads. The study cohort included all consecutive patients with biventricular devices from the Cleveland Clinic Prospective Extraction Registry who underwent device/lead removal from 2013 until 2022. Complete success was defined as complete removal of the device/lead without any remnants. Procedural complications were defined as any procedure related complication that occurred within the procedure. A total of 231 CS leads in 226 patients were included. The mean CS lead age was 6.1±4.0 years. Powered sheathes were used for 137 leads (59.3%). Patient-level evaluation of complete success was achieved in 216 patients (95.6%). Lead-level evaluation of complete success was achieved in 220 leads (95.2%). Major complications occurred in 5 patients (2.2%). The patients who had the CS lead extracted 1st had significantly higher incomplete removal rates than when the other leads were 1st removed. Multivariable analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent predictors of incomplete CS lead removal. Complete lead removal rate of long implant duration CS leads by TLE was 95% with a low incidence of major complication. Powered sheaths were required in approximately 60% of cases. CS lead age and the order that leads were extracted were the independent predictors of incomplete CS lead removal. Therefore, in general, physicians should extract other, stronger leads before attempting to extract the CS lead.