# Factors associated with complexity during transvenous lead extraction and confirmation of a very-low-risk subset

## TL;DR

The study identifies factors that increase the complexity of transvenous lead extraction and finds a subset of cases with very low risk.

## Contribution

Identifies a very-low-risk subset of transvenous lead extraction cases and factors associated with procedural complexity.

## Key findings

- Complex tools were used in 59.9% of transvenous lead extractions.
- Unplanned complexity was rare in pacemaker and ICD leads under 2 and 1 years old, respectively.
- Major intraoperative complications occurred in only 1.1% of cases.

## Abstract

Transvenous lead extraction/explantation (TLE) requires significant resources/coordination.

We sought to assess factors associated with the need for complex tools or a major intraoperative complication (complexity) with TLE.

This was a single-center, retrospective cohort study in patients undergoing TLE between January 2010 and March 2022.

There were 930 TLEs in 868 patients (age 62.9 ± 15.8 years, 68% men, 63% implantable cardioverter-defibrillators [ICDs], 1588 extracted leads, 29% infected). The median age of the oldest lead was 4.9 years (interquartile range, 1.9–8.1). Complex tools were used for 59.9% of TLE, including the laser (37.2%), laser and mechanical sheaths (9.2%), mechanical sheath (9.1%), snare and laser/mechanical (4.2%), and snare alone (0.1%). Complete success was achieved in 892 TLEs (95.9%). Complexity occurred with 59.9% of TLE (n = 557). Unplanned complexity occurred in only 2 of 203 pacemakers (1.0%), with the oldest lead being <2 years old and ICDs with the oldest lead being <1 year old. Factors independently associated with complexity included: number of ICD leads (P < .0001), combined lead age (P < .0001), number of transvenous leads (P < .001), abandoned leads (P = .0058), age at the time of implantation (P = .019), oldest lead age (P = .025), and patient age at TLE (P = .025). Major intraoperative complications occurred with 10 TLEs (1.1%). No major intraoperative complications occurred with traction alone.

Factors associated with complexity included the presence of an ICD, abandoned leads, patient age, and the number/age of leads. The risk of unplanned complexity is low for pacemaker leads <2 years and ICDs <1 year since implantation. This subset can be considered for TLE in the electrophysiology laboratory without immediate cardiac surgical backup.