[Analysis on the efficacy and safety of transvenous lead extraction in the treatment of patients with cardiac lead perforation].

Abstract

To investigate the efficacy and safety of transvenous lead removal (TLR) in the treatment of patients with cardiac lead perforation. The case data of 82 patients who underwent TLR for lead perforation at Peking University People's Hospital from January 2014 to June 2024 were retrospectively analyzed. The patients' age was (68.0±12.6) years, with 38 males and 44 females. Clinical symptoms of patients with lead perforation, characteristics of the perforated leads, operation success rate, complication incidence, tools used in TLR, and follow-up situation were analyzed. Clinical symptoms related to lead perforation were present in 80.5% (66/82) of patients, with chest pain being the most common [57.3%(47/82)]. Among the perforated leads, 6.1%(5/82) penetrated outside the pericardium, 58.5%(48/82) were delayed perforations, 65.9%(54/82) were active fixation leads, 78.0%(64/82) of the perforation sites were at the right ventricular apex, and 76.8%(63/82) had abnormal programmed lead parameters. The diagnosis of all lead perforations was confirmed by imaging examinations. Eight high-risk patients received percutaneous dry pericardiocentesis before surgery. Eighty-two patients underwent TRL surgery successfully, and no major complications occurred. Among the perforated leads, 57.3% (47/82) of the perforated leads were successfully removed manually. New leads were implanted in 91.5% (75/82) of patients during the same operation. Follow-up was conducted until August 2024, with a total follow-up duration of (5.1 ± 2.7) years. During the follow-up period, a total of 7 patients reached the end events, including 5 deaths and 2 patients who underwent TLR again. In experienced centers, TLR is a safe and effective treatment approach for cardiac implantable electronic devices lead perforation. Prophylactic dry pericardiocentesis can be used as an unconventional option.