Extraction of pacemaker and implantable cardioverter defibrillator leads: Patient and lead characteristics in relation to the requirement of extraction tools

Effective tools for extraction of pacemaker and ICD leads have been developed in the past decennium. This study investigated the necessity of using these tools in addition to direct traction in relation to patient and lead characteristics. The study encompasses first attempts at extraction of consecutive pacemaker and ICD leads from the subpectoral area. A stepwise extraction protocol was used with traction first (directly or with a locking stylet) followed by laser sheath extraction if not successful, The indication, patient age, time from implant, fixation mechanism, location, and insertion site of the leads were studied in relation to the outcome of traction. A total of 145 leads in 83 patients were extracted. Leads were implanted for 71 +/- 61 months. Indication for extraction was infection in 96 leads and malfunction in 49 leads. There were 90 ventricular leads including 16 ICD leads. Forty-nine (34%) leads were extracted with traction; in 96 (66%) leads a laser sheath was necessary. All leads implanted for < 6 months could be removed with traction alone. In a multivariate logistic regression model, time from implant was the main factor determining success of traction (P < 0.001), but in case of infection the success rate increased (P = 0.004). In conclusion, time from implant is the decisive factor to judge the potential efficacy of lead extraction with direct traction, If leads are implanted for 6 months, the availability of additional extraction tools is necessary when lead extraction is considered. In addition to time from implant, infected leads have a better chance to be removed with traction although it is a much weaker predictor.