P1763Outcome of remnant lead and tips after transveous lead extraction

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Background: Complete hardware removal is the recommended endpoint of cardiovascular implantable electronic device (CIED) transvenous extraction, specifically in cases of infection. However, complete extraction of chronic implants is not always achieved. Purpose: To assess outcomes of retained CIED hardware after lead extractions. Methods: We retrospectively analyzed the data of 147 pts who underwent CIED extraction during 2013-2015. Baseline characteristics and outcomes were compared between pts with remnant hardware to pts with complete removal. Results: In 18/147 (12%) complete hardware removal could not be achieved. There were no differences of comorbidities or CIED parameters between the two groups. Remaining hardware included 12 ventricular (9- ICD leads) and 6 atrial leads. Of those, 6 had passive fixation, 8 active and 4 of unknown type. Four were extracted with mechanical sheaths, 5 with laser sheath and in 9 a femoral approach was needed. One procedure was complicated by femoral vein tear. Of 18 pts with remnant hardware, 12 extractions were due to CIED infections: 10 systemic (5 with vegetation) and 2 pocket infections. The two pts with remnant leads both had a combined pocket and systemic infection, had relapse of infection at 19 and 6.6 months post extraction. The prior only had a remaining tip after extraction and was never re-implanted. The latter had a remaining part of electrode with a free end in the atrium. He had a fulminant course with valve endocarditis and underwent surgery for valve repair. In comparison, in the control group of complete hardware removal, there were no relapses of infection. This was significantly different between the groups (16.6% vs. 0% p= 0.01). Conclusion: In our study we could not identify baseline predictors for the detachment and remaining of leads or tips. This group had a relatively high infection recurrence rate but only in systemic infections. This finding advocates current guidelines complete removal in case of infection.

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