Large transvenous lead extraction study finds 95.7% of individual leads successfully removed

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A new, large study has found that 95.7% of individual leads have been successfully removed using transvenous lead extraction. The research was presented the Heart Rhythm Society’s 37th Annual Scientific Sessions, and includes data from both high volume and low volume medical centres.

The ELECTRa (European Lead Extraction Controlled) Registry, hosted by the European Heart Rhythm Association (EHRA), is the first multinational, multicentre, prospective registry of consecutive patients undergoing transvenous lead extraction. Data from 73 centres across 19 European Society of Cardiology countries were collected using a web-based system.

The primary objective was to evaluate the acute and long-term safety of transvenous lead extraction. The secondary objective included the description of patient characteristics, types of leads, indications for transvenous lead extraction, extraction techniques, success rates of transvenous lead extraction and the comparison between low and high volume centers. A high volume center is considered one that sees an average of 30 patients a year, and a low volume center sees less than 30 patients per year.

A total of 3,555 consecutive patients undergoing extraction of 6,493 leads were enrolled in the registry. Leads were extracted from the right atrium, right ventricle, coronary sinus and other locations. Major and minor complications were 2.7% and 5.2%, respectively. High volume centers had fewer major (2.4% vs. 4.1%) and minor (4.5% vs 8.1%) complications compared to low volume centers. Procedure-related major complications occurred in 58 patients (1.7%). The most common procedure related complications were cardiovascular complications requiring surgical repair, pericardiocentesis or chest drain insertion.

“The success rates of our study were higher than originally predicted, which is encouraging. This is the first time that we’re seeing the safety of transvenous lead extraction in a large group of patients on a prospective, consecutive basis, which is clinically important. We can now use these results to further testify that transvenous lead extraction is an effective option to improve the quality of care for patients undergoing lead extraction,” says Maria Grazia Bongiorni, University Hospital of Pisa in Pisa, Italy. “While we saw great success rates, device therapy still poses many risks and complications, so it’s important that we continue to explore and push the boundaries for new technologies like embracing leadless pacemakers as the way of the future.”

The authors also looked at 12-month follow-up data and observed 3.2% of complications related to infection and 5.2% of complications related to non-infection conditions.

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