Extraction of the permanent His bundle pacing lead: Safety outcomes and feasibility of reimplantation

Background Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. However, concerns remain about the feasibility and safety of lead extraction from the His bundle region. Objective The aim of our study was to assess the safety and feasibility of extraction of chronically implanted permanent HBP leads in addition to report on the feasibility of reimplanting in the His bundle region. Methods Patients undergoing extraction of leads from the His bundle location for standard indications were studied. The primary outcomes were removal success rates, need for extraction tools, and feasibility of reimplantation in the His bundle region. Results Thirty patients (male 23 (27%); mean age 73.3 ± 14 years) with permanent HBP leads of at least 6-month duration were included. The indications for removal of the HBP leads were infection (n = 3), lead failure (n = 22), nonfunctional lead (n = 3), and upgrade to implantable cardioverter-defibrillator (n = 2). The mean duration of the implanted leads was 25 ± 18 months (range 6–72 months). Removal of HBP leads was successful in 8 of 8 patients (100%) with ≤12-month duration and 21 of 22 patients (95%) with >12-month duration. Extraction tools were used in 4 patients, while manual traction was successful in the remaining patients. Reimplantation in the His-Purkinje conduction system was successful in 19 of 22 patients (86%). Conclusion In this largest study of HBP lead extractions, the overall success rate of extraction of chronically implanted HBP leads was high with a low complication rate. The need for mechanical extraction tools was low, and reimplantation in the His-Purkinje conduction system was feasible.