How old is too old? Outcomes of transvenous extraction in very long dwell time leads

Introduction

Lead dwell time significantly increases procedural complexity due to fibrotic adhesions along vascular, cardiac chambers and valvular systems. It 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.

Methods

Retrospective analysis of consecutive patients (P) undergoing transvenous lead extraction (TLE) between February 2013 and December 2024, comparing VLDT group (≥10 years) and a contemporary cohort of recent leads (<10 years, non-VLDTL group).

Results

Among 283P, 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; 93P had leads aged 10–20 years, and 8P >20 years. VLDTL were predominantly male (75.9%), with a median age of 75 years (59–81) and a median LVEF 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 CRT devices were more common in non-VLDTL Group (p=0.033).

VLDTL extraction required significantly more frequent use of the PT (p<0.001).

Although there were no differences regarding clinical success (95.7%), radiological success decreased significantly (85.1% vs 96.2%, p=0.001). Major and minor complications occurred in 5P and 7P, no significant differences compared to non-VLDTL (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 was 24.1% [Table 3]. VLDT group was a strong predictor of extraction failure, being associated with a more than fourfold increase in risk (OR 4.29, 95% CI 1.63–11.34, p=0.003).

Conclusion

Our single-center experience shows that although extraction of long dwell time leads entails greater procedural complexity, it increases the risk of procedural failure (radiological), but not of complications or mortality. That confirms safety and effectiveness of percutaneous extraction using the Pisa Technique even in very old leads.