Journal of Arrhythmia (Jun 2021)

Predictors of lead break during transvenous lead extraction

  • Junji Morita,
  • Kyohei Yamaji,
  • Michio Nagashima,
  • Yusuke Kondo,
  • Yohei Sadohara,
  • Jun Hirokami,
  • Rei Kuji,
  • Kengo Korai,
  • Masato Fukunaga,
  • Kenichi Hiroshima,
  • Kenji Ando,
  • Masahiko Goya

DOI
https://doi.org/10.1002/joa3.12524
Journal volume & issue
Vol. 37, no. 3
pp. 645 – 652

Abstract

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Abstract Background The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. Methods We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. Results A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07‐1.17; P < .001), passive leads (OR 2.29 95% CI 1.09‐4.80; P = .028), coradial leads (OR 3.45 95% CI 1.72‐6.92; P < .001), and insulators made of nonpolyurethane (OR 2.38 95% CI 1.03‐5.26; P = .04) as predictors of lead break. Broken leads needed longer procedure times and were associated with a higher rate of cardiac tamponade. Conclusions Lead age, coradial bipolar leads, passive leads, and leads without polyurethane insulation were predictors of lead break and could increase the difficulty of lead extraction.

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