By Hannah Woolley
Longer dwell times are related to higher rates of complication during lead extraction. There have been various studies looking at the risk factors for transvenous lead extraction but there is limited knowledge about extraction of leads that have been implanted for over 20 years.
Andrzej Kutarski (University of Lublin, Poland) and his colleagues have carried out a study to look at the risk of lead extraction after long dwell times. They aimed to compare the safety and feasibility of transvenous lead extraction in four different patient groups who had different lead dwell times.
To do this they carried out a retrospective analysis of their 12-year old transvenous lead extraction database (containing data from 2,654 transvenous lead extraction procedures), comparing the effectiveness and complications of the extraction procedures in the four groups (˂10 years, 10–19 years, 20–29 years and ≥30 years). The lead extractions were carried out using standard mechanical systems. Laser and radiofrequency energy equipped sheaths were not use and mechanical energy powered sheaths with rotating threaded tip were used sporadically (3.6%). The predominant major complication was cardiac tamponade, which occurred in 1.4% of cases.
Amongst the four groups, patients had comparable ages and there were more women in the 20–29 years and ≥30 years age group.
The analysis found that major complications and the need for rescue cardiac surgery increased as the lead dwell time increased and procedure success was higher the shorter the dwell time. Somewhat surprisingly the death rate was zero in the 20–29 years and ≥30 years age groups, although it was also very low in the ˂10 years age group (0.1%) and 10–19 years age group (0.7%)
The study found that there was a clear relationship between lead body dwell time and effectiveness and safety of the lead extraction procedure. A higher number of leads, abandoned leads and percentage of female patients seemed to be related to the effectiveness of lead extraction in patients with long lead dwell times but they concluded that lead body dwell time is one of many factors that affect the effectiveness of lead extraction and that other factors should be considered.
As they found that major lead extraction complications could occur during procedures with a relatively short dwell time, long dwell time should not be a reason for not carrying out lead extraction, especially in patients with a long life prognosis.