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Predictors and Outcomes of Transvenous Lead Extraction Requiring Femoral Bailout
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  • Yuval Shafir,
  • Eias Massalha,
  • Anat Milman,
  • Michael Glikson,
  • David Luria,
  • Avi Sabbag,
  • Roy Beinart,
  • Eyal Nof,
  • Eran Leshem
Yuval Shafir
Sheba Medical Center
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Eias Massalha
Sheba Medical Center
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Anat Milman
Sheba Medical Center
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Michael Glikson
Shaare Zedek Medical Center
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David Luria
Hebrew University of Jerusalem Faculty of Medicine
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Avi Sabbag
Sheba Medical Center
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Roy Beinart
Sheba Medical Center
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Eyal Nof
Sheba Medical Center
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Eran Leshem
Sheba Medical Center
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Abstract

INTRODUCTION: Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE requiring femoral vein bailout are poorly defined. We aimed to analyze predictors and consequences of TLE requiring femoral bailout. METHODS: A single tertiary center cohort of 421 consecutive patients who underwent TLE between May 2010 and February 2020 were analyzed. Venography was routinely performed before system upgrade to identify occluded veins. Patients were divided into 2 groups according to their need for femoral bailout extraction. RESULTS: A total of 928 leads were extracted with femoral bailout approach was needed in 71 leads(7.7%) among 49 patients(11.6%). A higher proportion of right ventricular(RV) leads required femoral bailout approach compared with right atrial(RA) leads[51/499(10.2%) vs 18/326(5.5%);p=0.02]. Femoral bailout was more common among younger patients, longer lead dwell time, more pocket entries, higher number of extracted leads, presence of abandoned leads and among patients with vascular occlusion. Following multivariate analysis, presence of abandoned leads, vascular occlusion and younger age remained a significant predictor for femoral bailout. Femoral bailout resulted in higher rates of major complications [5/49(10.2%) vs 12/372(3.2%);p=0.05] without intra-procedural mortality and no additional 30-day mortality[2/49(4.1%) vs 33/377(8.8%);p=0.39]. CONCLUSION: TLE of abandoned leads, occluded veins and younger age were found to be predictors of femoral bailout requirement. Despite higher rates of major complications in femoral TLE bailout, mortality was not increased. Venography prior to TLE should be considered for procedure planning.
03 May 2022Submitted to Journal of Cardiovascular Electrophysiology
03 May 2022Assigned to Editor
03 May 2022Submission Checks Completed
03 May 2022Reviewer(s) Assigned
Published in SSRN Electronic Journal. 10.2139/ssrn.4017056