Lead Extraction at a Pediatric/Congenital Heart Disease Center The Importance of Patient Age at Implant

OBJECTIVES This study sought to evaluate the safety and efficacy of transvenous lead extraction (TLE) at a single pediatric/congenital heart disease (CHD) center. BACKGROUND Data on TLE in pediatric and CHD patients are limited. METHODS Retrospective cohort study evaluating TLE from 2008 to 2019. RESULTS A total of 113 patients underwent TLE with 162 leads removed (including 38 high-voltage leads). Median age at lead implantation was 13 years (range 0.6-61.8 years), with a median age at extraction of 21.6 years (6.4-64.3 years). Median lead age was 7.2 years (1.0-35.3 years). Successful extraction occurred in 110 (97%) patients, 159 (98%) leads. Complex extraction was needed for 120 leads; 52 (44%) using laser alone, 27 (23%) mechanical sheath alone, and 21 (18%) using both. Femoral extraction was used for 19 (16%) leads. Risk factors for complex extraction were >-2 leads extracted (odds ratio: 3.36; 95% confidence interval [CI]: 1.2-9.36; P = 0.021), lead within the right ventricle (odds ratio: 2.8; 95% CI: 1.2-6.5; P = 0.017), and a combination of younger patient age at implant and older lead age at extraction, with patients #12 years of age at implant and leads >-7 years of age having an odds ratio: of 10.1 (95% CI: 2.21-45.9; P = 0.003). Major complications occurred in 5 (4.4%) of patients, with no mortality, but a high incidence of tricuspid valve injury. CONCLUSIONS TLE can be performed successfully and safely in a pediatric and CHD center. Patient age at lead implantation, not age at extraction, is an important predictor of needing a complex extraction, with younger patients at implant and older leads at extraction having the highest risk. (J Am Coll Cardiol EP 2022;8:343-353) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

This study evaluated the safety and efficacy of transvenous lead extraction (TLE) at a single pediatric/congenital heart disease (CHD) center, demonstrating that TLE can be performed successfully and safely in this setting.