Transvenous lead extraction can be efficacious and safe among patients with severely reduced ejection fraction (EF) and, in patients who decompensate, the early initiation of a left ventricular assist device along with a few simple steps can surmount myocardial damage. These findings were published in Heart Rhythm.
Researchers analyzed their experiences performing transvenous lead extraction among patients with severely reduced EF, including patients who received left ventricular (LV) support during transvenous lead extraction. The researchers conducted a retrospective review, reporting that from January 2008 until January 2022 they performed transvenous lead extraction on 245 patients with severely reduced EF and Stage D heart failure, Class I or Class II indications for extraction, and who were at high risk defined as poor surgical candidacy and 1 or more of the following factors: female sex, presence of dual coil leads, and leads older than 5 years.
The primary outcomes were clinical success and in-hospital mortality. Secondary outcomes included procedure-associated complications and length of hospital stay. The researchers performed a subgroup analysis to assess outcomes in the 8 patients experiencing transvenous lead extraction with LV assist devices.
There was clinical success in 97.6% of patients with severely reduced EF experiencing transvenous lead extraction and a mortality rate of 5.3%. The researchers found no statistically significant differences in primary outcomes or procedural complications among patient groups, including patients with preserved (275), midrange (504), or reduced (628) EF who received transvenous lead extraction. They also found no significant differences between the 8 patients experiencing transvenous lead extraction with LV assist devices and the other patients in the severely reduced EF group.
Some study limitations include the difficulty in replicating results due to it being a single-center case series performed in a tertiary cardiovascular care center with significant support capabilities. Also, all transvenous lead extraction was performed by 1 clinician, and the study lacks statistical power of multicenter randomized large-scale trials.
“Lead extraction in patients with [severely reduced] EF can be performed safely and effectively,” the researchers noted. “Adopting a few simple steps, including the early initiation of LV support, can overcome myocardial impairment in patients who decompensate.”
Disclosure: 1 study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Arora Y, Llaneras N, Carrillo R. Strategies and outcomes of patients with severely reduced ejection fraction (≤15%) undergoing transvenous lead extraction: a single center experience. Heart Rhythm. Published online August 7, 2022. doi:10.1016/j.hrthm.2022.07.032