Single center experience with femoral extraction of permanent endocardial pacing leads

Between March 1995 and June 1997, 128 leads were extracted from the hearts of 28 women and 50 men, 69 +/- 5 years of age (mean +/- SD, range 22-92 yea rs). The indications for the procedure were: Accufix leads in 18 patients ( 14%), dysfunction or incompatibility with ICD in 16 (12%), endocarditis on the lead in 41 (32%), pulse generator pocket infection in 28 (22%), and pul se generator and/or lead erosion in 25 patients (19%). The extraction was p erformed with a snare (lasso), via a femoral vein as a first approach in 11 6 leads, and as an alternate approach, after extraction from the original s ite of implantation had failed, in 12 leads. The leads had been implanted f or 62 +/- 48 months (range 1-205 months). A Cook sheath was used in 7, and a femoral approach traction in 20 instances. Of the 128 leads, 122 (95%) we re completely extracted, and 2 (2%) were partially extracted (the distal el ectrode remaining attached to the myocardium), and 4 (3%) could not be remo ved. Four complications occurred: 2 tears of the tricuspid valve without cl inical consequences, one separation of the lead's distal electrode which mi grated into the hypogastric vein, and one hemorrhage at the femoral punctur e site. There was no death or serious complication caused by lead extractio n in this series.