P177020 years later: a single referral hospital experience with CIED extractions

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Background: Cardiac implantable electronic device (CIED) use has increased exponentially over the past decade. As a consequence, there is a rise in CIED extraction cases. While CIED implantations are performed in most centers, extractions are considered a high risk and technically challenging procedure and are typically performed in tertiary specialized centers only. Purpose: The purpose of the study is to summarize data collected during 21 years of experience in lead extraction in a single Israeli referral center. Methods: All information of patients undergoing extractions including etiology for extraction, extraction tools, complications and outcomes was collected prospectively. We retrospectively compared procedural outcomes prior and after the introduction of the laser lead extraction technique. Results: During the years 1996-2016, 951 leads were attempted to be removed in 476 pts [332 (70%) of the cases were referrals]. Of them, 341 (71%) were extracted due to infection. Other causes for extraction were vein occlusion with need for device upgrade in 40 (8%) cases and lead malfunction in 25 (5%) cases. Complete removal of all leads was achieved in 906 (95%) leads, partial removal was achieved in 36 (4%) leads and failure in 9 (1%). Techniques for removal included simple traction in 272 (29%), locking stylets in 168 (18%), mechanical sheaths in 27 (2.8%), laser sheath in 199 (21%) and femoral approach was needed in 221 (23%). Overall severe intra-procedural complications rate was 19 (4%). This included 4 (0.8%) deaths, 4 (0.8%) tamponades and central venous tear in 6 (1.2%). In 6 (1.2%) there was a need for urgent conversion to open heart surgery. Comparison of cases prior to and after laser technique introduction in year 2012, showed that with laser, a smaller proportion of cases required the use of femoral approach [134/237 (56%) vs. 87/239 (36%) respectively; p<0.0001]. However, success rates for complete removal [433/456 (95%) vs. 473/495 (95.5%) respectively; p=0.66] and complication rates [9 (3.8%) vs. 10 (4.2%) respectively; p=0.83] did not differ prior to and after laser use. Conclusion: Transvenous CIED extraction is a relatively safe and successful procedure when performed in a specialized center. Introduction of laser lead removal resulted in lesser need to convert to femoral approach, albeit without improving success rates or preventing major complications.

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