Po-02-051 predictors of complexity with transvenous lead extraction

Transvenous lead extraction (TLE) often necessitates the use of complex tools (mechanical or laser sheaths) with cardiothoracic surgery on standby. Understanding factors associated with need for complex tools may obviate the need for surgical backup and/or the hybrid room in select patients. We sought to assess the factors associated with the need for complex tools or major intraoperative complication (complexity) at the time of TLE. Single-center retrospective review of electronic health records among patients undergoing TLE between January 2010 and March 2022. There were 930 TLE (patient age 62.9 ± 15.8 years, 68% men, 63% ICDs, 2.3 ± 0.8 leads, median oldest lead 4.9 IQR 1.9-8.1 years, combined lead age 9.5 IQR 3.6-16.8 years). The predominant indication for TLE was non-infectious (n=659, 71%). Complex tools were required for 557 TLE (60%), including the laser (n=456, 49%), mechanical tools (n=185, 20%), and femoral snare (n=41, 4%). Extraction was successful in 916 TLE (98%). Major intraoperative complications occurred with 11 TLE (1.2%), including emergent cardiac surgery in 10 TLE (1.1%) and 1 death (0.1%) in a patient who was not a surgical rescue candidate. All patients with a major intraoperative complication had complex tools used during TLE (100%). Univariate factors associated with the need for complex tools included: increasing age (p<.0001), HTN (p=0.002), CAD with PCI (p=0.09), history of AF (p=0.01), history of VT/VF (p<.0001), infection as indication for extraction (p=0.17), ICD (p<.0001), # of leads (p=0.0005), oldest lead age (p<.0001), combined lead age (p<.0001), and the presence of abandoned leads (p<.0001). Multivariate factors associated with need for complex tools included: ICD (p<.0001), # of leads (p<.0001), oldest lead (p=0.0027), and combined lead age (p<.0001). Among TLE with the oldest lead <2 years since implant (n=238, 45% ICDs), 8 (3%) required complex tools (75% were ICDs) and there were no major intraoperative complications. The frequency of major intraoperative complications was low (1.2%) and all occurred in patients in whom complex tools were used for TLE. Factors associated with complexity included presence of an ICD, and the number/age of leads. In the absence of additional risk factors, patients with lead age <2 years old are unlikely to require complex tools or have a major intraoperative complication. This subset can be considered for extraction in the EP lab instead of a surgical OR with immediate surgical backup.