Abstract Body (Do not enter title and authors here): Introduction: Longer lead dwell time is associated with worse outcomes during transvenous lead extraction (TLE). It has been suggested that risk may plateau beyond a certain dwell time but data on this are lacking.
Methods: We identified all TLE procedures at Emory Healthcare from 2007-2023. Clinical characteristics and procedural details were collected from medical records. Procedural outcomes were reported using the 2017 HRS/ACC/AHA consensus statement on TLE. Procedural success was defined as complete removal of all targeted lead hardware without any major complications. Clinical success was defined as retention of a small portion (<4 cm) of targeted lead which does not negatively impact the outcome of the procedure.
Results: We identified 1,717 TLE procedures. Mean patient age at extraction was 64.6 ± 15.1 yrs, 61.4% were male, 53% had ICD leads and 21% had CRT systems. Extraction indications included lead malfunction (46%), infection (38%) and venous occlusion with need for system upgrade (11%). The dwell time of the oldest lead targeted for extraction was < 1 yr (n=326, 19%), 1-5 yrs (n=633, 36.9%), 5-10 yrs (n=467, 27.2%), 10-15 yrs (n=178, 10.4%), 15-20 yrs (n=71, 4.1%) and >20 yrs (n=42, 2.4%). Procedural and clinical success rates decreased with longer lead dwell time (Figure 1A). Success rates were excellent (>95%) among leads <5 yrs old whereas success rates dropped to the 70-75% range for leads >20 years old. Most clinical failures among very old leads were due to inability to remove all lead material in the setting of infection. Across the entire cohort, the major complication rate was 1.3% and procedural death rate was 0.5%. Complications increased with increased lead dwell time (Figure 1B). Peri-procedural death occurred in 2.8% of cases with dwell times of 15-20 yrs. There were no major complications or deaths among dwell times of >20 yrs, however, the vast majority of these were pacemakers, not ICDs.
Conclusion: TLE success rates decrease and complication rates increase with increased lead dwell time, without any clear evidence of a plateau effect. These data have implications for making decisions about abandoning vs. extracting redundant leads.