AUTHOR=Milman Anat , Leshem Eran , Massalha Eias , Jia Karen , Meitus Amit , Kariv Saar , Shafir Yuval , Glikson Michael , Luria David , Sabbag Avi , Beinart Roy , Nof Eyal 

TITLE=Occluded vein as a predictor for complications in non-infectious transvenous lead extraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1016657

DOI=10.3389/fcvm.2022.1016657

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>The use of cardiovascular implantable electronic device (CIED) is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous lead extraction (TLE) can facilitate the re-implantation of new leads.</p></sec><sec><title>Aims</title><p>This study aims to explore predictors and complications of non-infectious TLE.</p></sec><sec><title>Methods</title><p>This study involves a retrospective analysis and comparison of characteristics, complications, and outcomes of patients with and without occluded veins (OVs) undergoing TLE at our center.</p></sec><sec><title>Results</title><p>In total, eighty-eight patients underwent TLE for non-infectious reasons. Indications for TLE were lead malfunction (62; 70.5%) and need for CIED upgrade (22; 25%). Fourteen patients referred due to lead malfunction had an OV observed during venography. The OV group (36 patients) were significantly older (65.7 ± 14.1 vs. 53.8 ± 15.9, <italic>p</italic> = 0.001) and had more comorbidities. Ejection fraction (EF) was significantly lower for the OV group (27.5 vs. 57.5%, <italic>p</italic> = 0.001) and had a longer lead dwelling time (3,226 ± 2,324 vs. 2,191 ± 1,355 days, <italic>p</italic> = 0.012). Major complications were exclusive for the OV group (5.5% vs. none, <italic>p</italic> = 0.17), and most minor complications occurred in the OV group as well (33.3 vs. 4.1%, <italic>p</italic> &lt; 0.001). Laser sheath and mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4 vs. 73.5%, respectively, <italic>p</italic> = 0.012). Procedure success was higher in the non-occluded group compared to the OV group (98 vs. 83.3%, respectively, <italic>p</italic> = 0.047). Despite these results, periprocedural mortality was similar between groups.</p></sec><sec><title>Conclusion</title><p>Among the TLE for non-infectious reasons, vein occlusion appears as a major predictor of complex TLE tool use, complications, and procedural success. Venography should be considered prior to non-infectious TLE to identify high-risk patients.</p></sec>