Difficulty and potential risks of single-lead atrioventricular synchronous pacing leads in transvenous lead extraction.

OBJECTIVES: The purpose of this study was to examine the factors affecting the outcome of successful lead extraction with an excimer laser sheath, which have not been clearly elucidated.

METHODS: Between January 2011 and December 2016 in our institution, 372 leads were intravenously extracted from 176 patients (mean age, 67 ± 15 years; 83% male) with the use of an excimer laser sheath. The mean time since lead implantation was 7.1 ± 6.7 years. Indications for this procedure were infection (76.1%), non-functional lead (11.3%), functional lead (9.7%) and others (2.9%).

RESULTS: The clinically successful removal rate was 96%. The procedural failure group had a longer time from implantation (P = 0.01), longer fluoroscopy time (P < 0.01) and greater use of a single-lead atrioventricular synchronous (VDD) pacing lead (P < 0.01) compared to the clinical success group. The significant factors of clinical failure were the use of a VDD-pacing lead (odds ratio 30.9, 95% confidence interval 5.8-165; P < 0.01) and the time from first implantation (odds ratio 1.1, 95% confidence interval 1.0-1.3; P = 0.02). In addition, there was no significant difference between the use of a VDD-pacing lead and the time from first implantation (P = 0.28).

CONCLUSIONS: A VDD-pacing lead is an unsuccessful factor of lead extraction. When performing VDD-pacing lead extraction, an operator should pay special attention to the procedure.