Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996

Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients bl as attempted at 226 centers, indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix(R) or Encor(R) leads (46%), Or other ca uses (2%). Patients were 64 +/- 17 years of age (range 5-96); 59% were men, 41% women. Leads were implanted 47 +/- 41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal rr as achieved for 93% of leads, partial Ibr 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P < 0.0002), less experienced physicians (P < 0.0001), ventricular leads (P < 0.005), noninfected patients IP < 0.0005), and younger patients (P < 0.0001). Major complications were reported for 1.4% of patients (< 1% at centers with > 300 cases), minor for 1.7%. Risk of-complications increased with number of leads removed (P < 0.005) and with less experienced physicians (P < 0.005); risk of major complications was higher for women (P < 0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.