Broken leads with proximal endings in the cardiovascular system: Serious consequences and extraction diffi culties

Abstract

Background: Retrospective analysis of effectiveness, technical problems, and complications of
transvenous extraction of leads with the free endings migrated to the cardiovascular system (CVS).

Methods: A 5-year-old database of transvenous lead extraction (TLE) procedures comprising
906 patients with 1563 leads being removed was analyzed. TLE procedures of leads migrated
in the CVS were compared with TLE procedures of leads with their proximal ends accessible
in the pacemaker/implantable cardioverter-defi brillator (PM/ICD) pocket.

Results: In our material, the phenomenon of leads migration occurred in 5% of patients referred
for TLE and affected most frequently unipolar and atrial leads. The presence of migrating
leads was associated with local venous occlusion in 64% of patients. Removal of migrating
leads required other techniques than extraction of leads with their proximal ends accessible in
the PM/ICD pocket. More than 95% of migrating leads were extracted transvenously, but procedures
were signifi cantly longer. The presence of other leads made extraction of migrated leads
even more complicated. Effectiveness and complication rates for removal of migrated leads and
leads accessible in the PM/ICD pocket were similar.

Conclusions: We postulate that every lead migrating in the CVS should be considered for
TLE. However, this extraction is technically more diffi cult and challenging than extraction of
leads accessible in the PM/ICD pocket.