Clinical Effectiveness and Safety of Transvenous Lead Extraction of Very Old Leads.

Background: Transvenous Lead extraction (TLE) success and safety are heavily influenced by lead dwell time.

Objective: In this study, we aim to compare the clinical effectiveness and safety of transvenous lead extraction between young and old leads.

Methods: We retrospectively identified all TLE procedures at Emory Healthcare from 2007-2023. Baseline patients' characteristics and procedural details were collected. The cohort was categorized based on the oldest lead dwell time in each procedure. The very long-dwell time (VLDT) group included all procedures with the oldest lead dwell time ≥15 years, whereas the control group included all procedures with the oldest lead dwell time <15 years. TLE outcomes were compared between the 2 groups.

Results: Of the 1717 TLE procedures, 114 procedures (6.6%) included leads with dwell times ≥15 years. Patients in the VLDT group were older and had a higher number of targeted leads. 57% of TLE in the VLDT group were for infectious indications. Lead extraction procedural and clinical success were significantly lower in the VLDT group compared to the control group (75% vs 95%, 83% vs 97%, p<0.001, respectively). There was a trend towards a higher major complications rate in the VLDT group compared to the control group (3.5% vs 1.3%, p=0.058).

Conclusion: TLE of VLDT leads has a lower procedural and clinical success and a higher complication rate than TLE of leads with a shorter dwell time. These results will allow electrophysiologists to quantify risks and benefits of abandoning leads at the time of lead revisions or upgrades.