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Introduction: Transvenous lead extraction (TLE) is generally considered a safe procedure, albeit not without risks. While gender‐based disparities have been noted in short‐term outcomes following TLE, a notable gap exists in understanding the long‐term consequences of this procedure. The objective of this analysis was to investigate sex differences in both acute and long‐term outcomes among patients who underwent TLE at a tertiary referral center. Methods: In this retrospective cohort study, consecutive patients who underwent TLE between January 2014 and January 2016 were enrolled. The primary outcome comprised a composite of all‐cause mortality and need for repeated TLE procedures. Secondary outcomes included fluoroscopy time, lead extraction techniques, success rates, and major and minor complications. Results were compared between female and male cohorts. Results: The study population comprised 191 patients (median age, 70 years), 29 (15.2%) being women and 162 men (84.8%). Study groups had similar baseline characteristics. Complete procedural success was achieved in 189 out of 191 patients (99.0%), with no significant difference observed between the two groups (p =.17). No major complications were reported in the total cohort. However, there was a significantly higher incidence of minor complications in women compared to men (17.2% vs. 2.5%, p <.01). Following a median follow‐up of 6.5 years, the incidence of the primary composite outcome occurred similarly between the study groups (log‐rank p =.68). Conclusion: Women who underwent TLE exhibited a significantly higher incidence of minor acute intra‐ and peri‐procedural complications than men. However, no differences in long‐term outcomes between genders were observed. [ABSTRACT FROM AUTHOR]

Introduction: Pacing leads with extendable‐retractable helix (EHL) are alternatives to fixed‐helix leads (FHL) for conduction system pacing (CSP), but data on handling characteristics are limited. This study evaluated a dual‐center experience of lead handling and performance during CSP. Methods and Results: Consecutive patients with His‐bundle pacing (HBP) or left bundle branch pacing (LBBP) were evaluated for the primary outcome of lead failure, defined as structural damage to the lead necessitating lead replacement. Differences in pacing characteristics were compared. Among 280 patients (mean age 74 ± 11 years, 44% male, 50% LBBP), 246 (88%) received FHL and 34 (12%) received EHL. Of 299 leads used, lead failure occurred more frequently among patients with EHL than FHL (29% vs. 2%, p <.001), regardless of CSP modality. Majority of damaged leads (89%) in the form of helix deformation were successfully removed, with failure occurring in only two patients, both EHL, leading to helix fracture and retention within the septal myocardium. EHL, compared to FHL, was associated with 25‐fold increased odds of lead failure (odds ratio: 25.21, 95% confidence interval: 7.35–86.51), and persisted after adjustment in turn for age, pacing modality and indication. CSP implant success rates did not differ by lead design (FHL 80% vs. EHL 71%, p =.18), with similar pacing thresholds at implant and follow‐up. Conclusion: Helix deformation and fracture were more frequent with EHL in CSP despite similar implant success. These findings have significant implications for lead selection during CSP and raises concerns about the long‐term extractability of EHL in CSP. [ABSTRACT FROM AUTHOR]

Background: Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX. Methods and Results: Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X‐ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%. Conclusion: Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance. [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic device (CIED) infections associated with large, mobile vegetation adds to the complexity of lead extraction and is associated with significant patient morbidity and mortality. Objective: To show the feasibility of concomitant cardiovascular implantable electronic device extraction and vacuum‐assisted removal of lead‐related vegetations. Methods: This is a single‐center retrospective case series of consecutive patients with persistent bacteremia, sepsis, or endocarditis despite medical therapy who have vegetations >2 cm and subsequently underwent immediate CIED lead extraction after debulking with vacuum‐assisted suction. Results: Eight patients underwent successful removal of 17 leads immediately after debulking of vegetations with vacuum‐assisted device suction. Debulking procedure was not successful in 1 patient due to inability to direct the vacuum suction device into proper position. There were no intraprocedure complications related to the vacuum‐assisted debulking. One patient required open sternotomy for tear of the coronary sinus ostium related to extraction of a left ventricular pacing electrode. There was no mortality within 30 days of the procedure. Conclusions: Based upon these clinical results, it is feasible for patients with infected CIED systems that have large right‐sided vegetations to undergo vacuum‐assisted debulking then immediately followed by percutaneous CIED removal in whom surgical removal is considered high risk. [ABSTRACT FROM AUTHOR]

LV Lead Extraction and Reimplantation. Background: Early series of biventricular device removal have contained mostly younger cardiac venous (CV) left ventricular leads and few have reported on rates of successful reimplantation. Methods and Results: We performed a retrospective analysis of all patients referred to the Cleveland Clinic between February 2, 2001 and July 27, 2011 for removal of a biventricular device with a CV pacing lead for an infectious indication. A total of 173 patients were included. The median age of the CV leads was 22.3 months (interquartile range: 5.2-46.3 months). The complete procedural success rate for all leads was 97.7%, with the remaining 2.3% clinical successes. A total of 76.9% of CV leads were removed using simple traction alone with the remaining leads requiring the use of a laser-powered sheath. A total of 3.5% of leads required intervention (manual dissection or laser-powered dissection) within the coronary sinus (CS). Major complications occurred in 1.2% of patients. Minor complications occurred in 7.5% of patients, the majority of which were hematomas requiring drainage (6.9%). CV lead reimplantation was attempted in 107 patients of which 88 (82.8%) were successful. Conclusion: CV lead removal in patients with an infected biventricular device is associated with an extremely high procedural success rate and a low incidence of major complications. The use of a laser-powered sheath is necessary in roughly one-quarter of cases with a very small percentage requiring intervention within the CS. Reimplantation of CV leads is achievable in roughly 83% of patients, a figure lower than nationally quoted estimates for de novo implantations. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1213-1216, November 2012) [ABSTRACT FROM AUTHOR]

It is unknown how many pacemaker and implantable cardioverter defibrillator (ICD) leads perforate during lead placement. Symptoms of a perforated lead include shortness of breath and chest pain. Signs of perforation can include a high pacing threshold, reduced lead sensing, and a high lead impedance. We present the case of a patient where perforation of the single coil right ventricular lead was not evident in imaging but incidentally detected during operative aortic valve replacement. The lead perforation rate during device implantation is around 1%—ICD leads have a higher perforation rate. [ABSTRACT FROM AUTHOR]