The number of cardiac implantable electronic devices is growing worldwide because
they play a relevant role in improving the survival rate in patients with specific
heart diseases. Cardiac implantable electronic devices complications including infection,
dysfunction or venous stenosis increase the need for the least traumatic way to explant
leads. Our goal was to report the successes and procedural complication rates of transvenous
lead extraction (TLE) in a consecutive series of patients.From 2010 to 2016, 108 patients
underwent TLE of 227 leads due to endocarditis (n = 21; 19%), pocket infection (n
= 58; 54%) or lead dysfunction (n = 29; 27%). In 98% (n = 106) of the patients, laser-assisted
lead extraction was performed. In 2% (n = 2) of the patients, the application of a
solitary locking stylet was sufficient. The patient mean age was 68 ± 14 years; 25%
of the patients had previous cardiac surgery. TLE was performed a mean of 9 ± 6 years
after the implantation of the existing device.Complete procedural success (removal
of all lead material from the vascular space) was achieved in 98.7% (n = 224), and
clinical success (achievement of all clinical goals associated with the indication
for lead removal and absence of major complications) was achieved in 98% (n = 106).
In 2 patients the procedure failed due to a vascular tear requiring a thoracotomy.
In 1 patient, complete lead extraction was not possible due to heavy calcification
(coronary-sinus lead). The 30-day mortality rate was 3.7% (n = 4); the patients died
of multiorgan failure (n = 1), cardiac failure (n = 1) and septicaemia (n = 2). The
procedure-related major complication rate was 2% (n = 2).Laser-assisted TLE seems
to be a safe and effective procedure with an acceptable complication rate.
