The successful removal of lead wires implanted for conduction system pacing has been shown to be feasible, according to a multicenter study. In 91% of the 341 patients included in the study, the leads were removed with manual traction alone. The success rate was quite high for leads attached to the His bundle (90%) and those placed in the left bundle branch area (92%). Additionally, the overall removal process was considered a complete success in 99% of cases, with all targeted leads and lead material being removed without any permanently disabling complications or death.
Despite the efficient removal process, there are some challenging characteristics associated with the extraction of conduction system pacing leads. The mean lead dwell time was 22 months, indicating a potential risk of complications for longer-dwelling leads. Concerns about lead architecture, such as breaking at their septal insertion point or damaging the tricuspid valve, were also noted. This raises questions about the safety and feasibility of extracting these leads, especially considering their location in either the His bundle or left bundle branch area.
Study discussants emphasized the importance of expertise in lead extraction, as well as the potential risks associated with older lumenless leads. Dr. Matthew Zipse highlighted the need for caution when dealing with stylet-driven leads, pointing out the challenges presented by the lumenless lead architecture. He also stressed the importance of countertraction and the use of extraction sheets to minimize the risk of venous tear and tricuspid damage during the removal process. It was noted that no patient with a His bundle pacing lead experienced new severe tricuspid regurgitation suggestive of valve damage from lead removal.
In light of the findings from the multicenter study, there is a call for creating a registry to monitor the failure rates, functionality, and extractability of conduction system pacing leads. This registry would help assess the long-term outcomes of these leads and provide valuable insights for future extraction procedures. As newer defibrillator leads with similar functionality are being introduced to the market, it is essential to have a comprehensive understanding of the challenges and risks associated with lead wire removal for conduction system pacing.
Overall, while the removal of lead wires used for conduction system pacing has shown promising success rates, there are still complexities and potential risks that need to be carefully considered. By fostering collaboration among experts and establishing registries for monitoring lead functionality, the field can continue to advance and improve the safety and feasibility of lead extraction procedures.
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