Risk of Collateral Lead Damage in Percutaneous Cardiac Implantable Electronic Device Extraction

Abstract

Objectives: This study sought to assess the risk of collateral lead damage during cardiac implantable electronic device extraction.

Background: With the increasing numbers of cardiovascular implantable electronic devices, there has been an increase in the number of percutaneous device and lead extractions. It is unknown how often collateral damage (defined as the need for unintended lead extraction, or loss of lead's integrity or dislodgement) occurs in the planned retained leads.

Methods: In this retrospective study, 108 patients who underwent incomplete cardiovascular implantable electronic device removal at the University of California, San Diego from September 2010 to September 2015 were included. The authors established the integrity of previously functioning leads at the end of each procedure as well as on follow-up visits using parameters including lead impedance change, threshold change, drop in P- or R-wave signal amplitude, or presence of lead noise.

Results: Only 4 of 143 leads (2.7%) were found to have collateral damage. One right atrial (RA) lead had a clear insulation break, the second RA lead was found dislodged, and the third RA had a constant noise. The right ventricular lead was found to have a new high pacing threshold. Collateral lead age, extracted lead implantation site, collateral lead implantation site, and mode of lead extraction (laser, traction, or rotational dilator) did not have a significant correlation with the outcome of collateral lead damage.

Conclusions: Lead extraction can be performed safely; however, there is a small risk of damaging adjacent leads. Close follow-up is needed, especially for the first few months, to assess for the reconnected leads' integrity.

Keywords: collateral damage; laser lead extraction; leads extraction.