Transvenous Lead Extraction in Patients with Grownup Congenital Heart Disease

Objectives: Up to 80% of patients born with congenital heart disease (GUCH) nowadays survive to adulthood. Therefore, the number of patients with grown-up congenital heart disease, which have been treated with cardiac implantable electronic devices (CIED) increase significantly. Due to complex corrective surgeries and long dwell time of CIEDs in such patients, transvenous lead extraction can be difficult and a high-risk procedure. We therefore investigated safety and efficacy of transvenous extraction of leads in patients with GUCH.

Methods: Between January 2013 and March 2020, a total of 320 patients underwent lead extraction in a high-volume lead extraction centers. 10 patients were grown-ups with different congenital heart diseases (e.g., atrioventricular septal defect, double outlet right ventricle, transposition of the great vessels). Laser lead extraction was the primary extraction method, with additional use of mechanical rotational sheaths or femoral snares, if necessary. All procedural- and patient-based data were collected into a database and retrospectively analyzed.

Result: Mean patient's age was 38 ± 13 years, 70% were male. Indications for lead extraction were lead dysfunction (50%), endocarditis/pocket infection (30%), skin perforation and an upgrade (10%). 27 leads had to be extracted. The mean lead dwell time of treated leads was 12.2 ± 7.5 years. Complete procedural success was achieved in 80% of cases, while clinical success was achieved in 100%. Additional mechanical rotational sheaths or femoral snares were used in 2 (20%) patients. Overall complication rate was 0%, without any major or minor complications. There was no procedure-related mortality.

Conclusion: Transvenous lead extraction in patients with grown-up congenital heart disease is safe and effective when performed in specialized centers with a very low complication rate despite the presence of very old leads.

Publication History

Article published online:
19 February 2021