Prevalence and leading causes of transvenous lead extraction for nonfunctional leads in a real-world setting: a 5-year multicenter overview
G Mitacchione, G Coppola, V Schillaci, E C L Pisano, D Carretta, A Di Grazia, D Castagno, S Torre, S Bandino, F Perna, F Migliore, R Rordorf, P Mazzone, F Solimene, A CurnisAbstract
Background
Transvenous lead extraction (TLE) is increasingly performed in the management of cardiac implantable electronic devices (CIEDs), with infection representing the most common indication. Conversely, indications for TLE due to non-infectious causes—encompassing a variety of clinical scenarios—still carry a low class of recommendation and are supported by limited evidence. In this context, the management of nonfunctional leads has emerged as a major concern, given the growing recognition of this issue.
Purpose
the aim of this study was to assess the prevalence of TLE for non-infectious causes in a real-world clinical setting, with a particular focus on the management of non-functional leads and the decision-making process concerning these patients.
Methods
consecutive patients who underwent TLE between 1 January 2020 and 31 December 2024 across 12 centers experienced in TLE procedures were included in the analysis. Each center provided data on TLE indications; in cases involving nonfunctional leads, additional clinical details were collected. Moreover, all centers completed a survey questionnarie designed to evaluate their approach to extracting nonfunctional leads and the main factors influencing such decisions.
Results
in this 5-year multicenter retrospective analysis, among 2334 TLE procedures, infectious indication accounted for the majority (71%), while the remaining 29% were due to non-infectious causes (Figure 1A). Among these, the predominant reason (23%) was the presence of nonfunctional leads, 65% of which were high-voltage, although an increasing trend in pacing lead extraction was observed over time (Figure 1B). Lead dysfunction was the most common cause of lead non-functionality. Although lead abandonment was technically feasible in the majority of patients due to preserved venous patency (77% ICD patients - 83% PM patients) (Figure 2A), TLE was performed nonetheless. According to the survey, all participating centers preferred extraction of nonfuncitonal leads rather than abandonment, regardless of whether a conservative alternative was technically feasible. The primary rationale for this approach was to avoid future complex TLE procedures associated with abandoned leads and prolonged dwell times. This strategy was particularly adopted in younger patients, in whom long-term risk was considered more significant. This behaviour was supported by the centers’ experience, showing that up to 30% of TLE procedures for infection involved abandoned leads, further complicating extraction (Figure 2B).
Conclusion
in a real-world setting, non-functional leads accounted for nearly one-quarter of all TLE procedures and were mainly due to lead dysfunction. Despite the low class of recommendation and the availability of conservative alternatives, extraction of nonfunctional leads is often regarded as a preventive strategy—especially in younger patients—to mitigate the risk of more complex and hazardous procedures in the future.Figure 1Figure 2