Outcomes of transvenous lead extraction in patients with lead perforation: A single-center experience

Background Management of cardiac perforation caused by the lead of a cardiac implantable electronic device (CIED) is currently unclear. This study evaluated the outcomes of transvenous lead extraction (TLE) in patients with cardiac perforation caused by a transvenous lead. Hypothesis Removal of perforated lead by transvenous approach is safe and effective. Methods The medical records of all patients diagnosed with cardiac perforation by a pacing or defibrillator lead in Peking University People's Hospital from January 2008 to January 2019 were reviewed. We included patients who were managed by TLE. Results A total of 53 patients (30 men; mean age: 67 +/- 15 years) with lead perforation managed by TLE were included. Most of the perforated leads (94.9%) were pacemaker leads. Forty-three leads (81.1%) were implanted within 1 year. Ten patients with a high risk of hemopericardium underwent percutaneous subxiphoid pericardial puncture prior to TLE. All 53 culprit leads were removed completely without major complications. Simple traction with or without a locking stylet was sufficient in 51 patients (96.2%). Forty-eight patients (90.6%) had a new active-fixation lead reimplanted. No patients showed evidence of new-onset or worsening pericardial effusion during the procedure and hospital stay. During a median follow-up time of 16 months, no recurrence of symptoms associated with lead perforation or CIED-related infection were reported. Conclusion In most patients with lead perforation, TLE can be a safe and effective management approach.