The Feasibility of Removing Conduction System Pacing Leads: A Critical Analysis

The Feasibility of Removing Conduction System Pacing Leads: A Critical Analysis

A multicenter study presented at the Heart Rhythm Society (HRS) annual meeting discussed the success rate of removing lead wires implanted for conduction system pacing. According to the study led by Pugazhendhi Vijayaraman, MD, of the Geisinger Heart Institute, leads were successfully removed with manual traction alone in 91% of the 341 patients. The study showed a rate of 90% for leads attached to the His bundle and 92% for those placed in the left bundle branch area, indicating that lead removal was feasible in the majority of cases.

While the study reported a high success rate in lead removal, it also highlighted some complications and challenges associated with the procedure. Vijayaraman noted that removal was a complete success in 99% of cases, with no permanently disabling complications or deaths. However, the mean lead dwell time was 22 months, raising concerns about the predictability of outcomes in older leads. The study also pointed out worries about lead architecture, the potential for leads breaking, and the risk of damaging the tricuspid valve during extraction.

Expert Opinion

Matthew Zipse, MD, of the University of Colorado, expressed concerns about the unknowns associated with newer lumenless lead architectures. He emphasized the importance of being mindful of potential complications, such as lead unraveling, especially in older lumenless leads. Zipse also highlighted the value of countertraction and the use of extraction sheets to minimize risks of venous tears and tricuspid damage. It was noted that the operators involved in the study were experts in lead extraction, which may have influenced the outcomes.

Based on the findings of the study, it was suggested that creating a registry for all conduction system pacing leads could be beneficial. This registry would assess the failure rates, functionality of the leads, and extractability of those leads. With the industry providing newer defibrillator leads with similar functionality, having a comprehensive registry could help in monitoring and evaluating the performance of these leads in the long term.

While the study demonstrated a high rate of success in removing conduction system pacing leads, there are still challenges and uncertainties that need to be addressed. By continuing to monitor outcomes, assess risks, and implement best practices in lead extraction, healthcare providers can ensure the safe and effective removal of these leads in patients. More research and collaboration within the medical community will be essential in improving the feasibility and safety of lead removal procedures.

Health

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