No laser, no limits: fifteen years of mechanical transvenous lead extraction in a tertiary cardiac centre in asia

Background/Introduction

Transvenous lead extraction (TLE) is an essential component of cardiac implantable electronic device management. While large Western registries have established procedural safety and efficacy benchmarks, data from Asian centres remain limited.

Purpose

To describe the indications, techniques, procedural success, safety and long-term outcomes of TLE performed over a fifteen-year period in a tertiary cardiac centre in Asia.

Methods

All TLE procedures between 2010 and 2024 were retrospectively reviewed. Demographic, clinical, procedural and outcome data were collected. Patients with lead dwell time >1 year or requiring specialized extraction tools were included. Simple traction, lead-locking stylets, telescoping sheaths, rotating mechanical sheaths and femoral workstation and snares were used in a stepwise fashion. Laser tools were not available. Endpoints included complete lead removal, clinical procedural success and complications defined according to EHRA criteria. Follow-up data at 12 months were obtained from clinical records.

Results

142 patients were included (mean age 62.4 ± 13.9 years; 71.1% male). 91.5% were performed in the operating theatre under general anaesthesia. In total, 213 leads were extracted (mean 1.5 leads per patient; dwell time 6.7 ± 4.4 years). Lead dysfunction (69%) was the most common indication followed by infection (25.4%). Extracted systems comprised 61 PPM, 2 CRT-P, 68 ICD and 11 CRT-D devices. In total, 128 PPM leads, 72 ICD leads and 13 CRT leads were removed. Simple traction was successful in 43 patients (30.3%), while the remainder required mechanical extraction tools. Lead-locking stylets were used in 99 procedures (69.7%), polypropylene sheaths in 89 (62.7%), metal sheaths in 74 (52.1%), rotating mechanical sheaths in 13 (9.2%) and a femoral workstation with snares in 7 (4.9%).

Complete lead removal was achieved in 94.4% (n=134) and clinical procedural success in 99.3% (n=141). 8 patients (3.8%) had retained fragments, with one exceeding 4cm. Retained fragments occurred more frequently in cases with longer lead dwell time, ICD leads and multi-lead extractions. No major complications or procedure-related deaths occurred. Minor complications occurred in 4 patients (2.8%) – three hematomas and one pneumothorax. All responded to conservative management. At 12 months, 2 patients (1.4%) had died of non-cardiovascular causes.

Conclusion

Over a fifteen-year period, TLE performed exclusively with simple traction and mechanical extraction tools in a tertiary Asian centre was associated with high procedural success and a low complication rate. Despite the absence of laser extraction systems, outcomes were comparable to major international registries, supporting the safety and efficacy of a predominantly operating-theatre-based mechanical extraction strategy in contemporary practice.Baseline And Procedural CharacteristicsTransvenous Lead Extraction Histograms