Transvenous laser lead extraction in patients with congenital complete heart block

BACKGROUND Data on lead management in patients with congenital complete heart block (CCHB) with cardiac implantable electronic devices are lacking. OBJECTIVE The purpose of this study was to describe the natural history and outcomes in patients with CCHB with cardiac implantable electronic devices undergoing transvenous lead extraction (TLE). METHODS Data on all attempted TLE procedures in patients with CCHB at 2 institutions between 2011 and 2021 were collected from a retrospective registry. RESULTS Overall, 16 patients (mean age at transvenous device implant 13.8 +/- 4.7 years) were included. Before TLE, patients underwent an average of 2.25 +/- 1.3 generator changes, 3 (19%) underwent cardiac resynchronization therapy upgrade, and 7 (44%) underwent a lead revision with subsequently abandoned leads. Mean patient age at TLE was 34.4 +/- 9.4 years with a mean duration of lead implant of 19.2 +/- 6.9 years. Lead malfunction (n = 11 [69%]) and infection (n = 5 [31%]) were the most common indications for TLE. A total of 38 leads were removed, with complete procedural success achieved in 14 of 16 (87.5%). Two (12.5%) major complications occurred, including right ventricular laceration and superior vena cava tear requiring sternotomies. All patients survived at 1-year follow-up. CONCLUSION Patients with CCHB represent a unique cohort highlighted by several generator changes, lead revisions, and abandoned leads at a young age, along with a long duration of lead dwelling time and a high prevalence of lead malfunction requiring TLE. There may be a high risk of major complications during TLE, suggesting TLE should be performed only in experienced centers. Larger studies are needed to confirm these findings.

Automated summary

This study examined the outcomes of transvenous lead extraction (TLE) in patients with congenital complete heart block (CCHB) with cardiac implantable electronic devices. The results showed a high risk and the need for experienced centers in lead management for CCHB patients.