Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996

Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each y ear, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic o r infected leads evolved over a 5-year period (1989-1993). This article ana lyzes results from January 1994 through April 1996, a period during which t echniques were fairly stable. Extraction of 3,540 leads from 2,338 patients bl as attempted at 226 centers, indications were: infection (27%), nonfunc tional or incompatible leads (25%), Accufix(R) or Encor(R) leads (46%), Or other ca uses (2%). Patients were 64 +/- 17 years of age (range 5-96); 59% were men, 41% women. Leads were implanted 47 +/- 41 months (maximum 26 year s), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attem pted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete remo val rr as achieved for 93% of leads, partial Ibr 5%, and 2% were not remove d. Risk of incomplete or failed extraction increased with implant duration (P < 0.0002), less experienced physicians (P < 0.0001), ventricular leads ( P < 0.005), noninfected patients IP < 0.0005), and younger patients (P < 0. 0001). Major complications were reported for 1.4% of patients (< 1% at cent ers with > 300 cases), minor for 1.7%. Risk of-complications increased with number of leads removed (P < 0.005) and with less experienced physicians ( P < 0.005); risk of major complications was higher for women (P < 0.01). Gi ven physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low comp lication rates.