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Very Long-Dwell Time Leads: still a concern in Transvenous Lead Extraction? Safety and clinical outcomes
Session:
Sessão de Posters 29 - Pacing sem elétrodos e inovação em dispositivos
Speaker:
Leonor Magalhães
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Leonor Magalhães; Raquel França Moreira; Margarida G. Figueiredo; Sofia Jacinto; Helder Santos; Guilherme Portugal; Pedro Silva Cunha; Ana Lousinha; Pedro Coelho; Rui Cruz Ferreira; Bruno Valente; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction: </span></strong><span style="font-family:"Calibri",sans-serif">Lead dwell time significantly increases procedural complexity due to fibrotic adhesions along the venous system, cardiac chambers, and tricuspid valve, and is a major predictor of extraction failure and complications. The Pisa Technique (PT), a rotational sheath–based approach, has shown low complication rates in large registries. We aimed to assess the safety and efficacy of very long dwell time lead (VLDTL) extraction.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods: </span></strong><span style="font-family:"Calibri",sans-serif">Retrospective single-center analysis of consecutive patients undergoing transvenous lead extraction (TLE) between February 2013 and December 2024, comparing those with VLDTL group (≥10 years) with a contemporary cohort with recent leads (<10 years, non-VLDTL group). Demographics, procedural characteristics, clinical and radiological success, complications, and mortality were analyzed.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results: </span></strong><span style="font-family:"Calibri",sans-serif">Among 283 patients, 116 underwent VLDTL extraction (227 leads), with a median dwell time of 149 months (IQR 132–180), compared with 48 months (36–84) in the non-VLDTL Group. The longest implanted lead reached 432 months; 108 patients had leads aged 10–20 years, and 8 patients >20 years. VLDTL patients were predominantly male (75.9%), with a median age of 75 years (59–81) and a median left ventricular ejection fraction of 55% (50–60). Baseline characteristics were largely comparable, except for a lower prevalence of diabetes mellitus (p=0.047), dilated cardiomyopathy (p=0.006), and LVEF <50% (p=0.039) in the VLDTL group. VLTDL group had a higher proportion of CIED infection as extraction indication (83.2% vs 70.3%, p=0.017) and differences in device types (CRT devices more common in non-VLDTL Group; p=0.033).[ Table 1].<br /> VLDTL extraction required significantly more frequent use of the PT (p<0.001) [Table 2]. There were no differences regarding clinical success (with a high rate of 95.7%), however radiological success decreased significantly compared to non VLDTL group (85.1% vs 96.2%, p=0.001). Major and minor complications occurred in 5 and 7P, respectively, without significant differences between groups (p=0.126 and p=0.070). No intraprocedural deaths were recorded. 7 in-hospital deaths occurred, only one procedure-related. Over a median follow-up of 36 months (15–76), all-cause mortality reached 24.1% [Table 3]. VLDT group was a strong predictor of extraction radiologic failure, being associated with a more than fourfold increase (OR 4.29, 95% CI 1.63–11.34, p=0.003).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion: </span></strong><span style="font-family:"Calibri",sans-serif">Our single-center experience shows that although extraction of long dwell time leads entails greater procedural complexity and danger, it increases the risk of procedural failure (radiological), but not of complications or mortality. That confirms that percutaneous extraction using the Pisa Technique is safe, feasible, and highly effective even in very old leads.</span></span></span></p>
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