Late complications of electrotherapy — a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience

Abstract

Background: Despite advances in electrotherapy, late complications constitute an increasing clinical and therapeutic problem.
Transvenous lead extraction (TLE) is becoming a safe and effective approach to the treatment of such complications.

Aim: To assess indications for TLE and to evaluate safety and efficacy of TLE procedures.
Methods: A retrospective clinical analysis of 100 patients with complications of electrotherapy admitted to a tertiary care
centre in 2008–2011.

Results: In 2008–2011, the number of electrotherapy complications increased markedly. The most frequent reason for TLE was
lead dysfunction (62% of patients, including 31% with an implanted cardioverter-defibrillator [ICD] and 31% with a pacemaker
[PM]). The most common type of lead dysfunction was conductor damage (38% of patients, including 23% with ICD, 15%
with PM), followed by late myocardial perforation (14% of patients, including 7% with ICD, 7% with PM), abnormal course
of the lead (7% of patients, including 1% with ICD, 6% with PM), and lead insulation failure (3% of patients). Other reasons
for TLE were infectious complications (24% of patients, including 15% with PM pocket infection), venous insufficiency (17%
of patients, including 10% in whom an indwelling lead was a direct obstacle to switching the pacing mode), and the need to
switch the pacing mode (4% of patients). Procedural efficacy was 96% (lead fragments were left in place in 4% of patients).
No significant clinical complications were observed in any of the patients in the periprocedural period.

Conclusions: Clinical manifestations of electrotherapy complications in the study group varied and included a relatively small
number of infectious complications (24%) and a relatively large number of late myocardial perforations (14%). Efficacy and
safety of the procedures were very high.