Extraction of pacemaker and implantable cardioverter defibrillator leads: XXXX and lead characteristics in relation to the requirement of extraction tools.

@entity1479 @entity1 @entity281
Effective tools for extraction of pacemaker and @entity1479 leads have been developed in the past decennium. This study investigated the necessity of using these tools in addition to direct traction in relation to @entity1 and lead characteristics. The study encompasses first attempts at extraction of consecutive pacemaker and @entity1479 leads from the subpectoral area. A stepwise extraction protocol was used with traction first (directly or with a locking stylet) followed by laser sheath extraction if not successful. The indication, @entity1 age, time from implant, fixation mechanism, location, and insertion site of the leads were studied in relation to the outcome of traction. A total of 145 leads in 83 @entity1 were extracted. Leads were implanted for 71 +/- 61 months. Indication for extraction was @entity281 in 96 leads and malfunction in 49 leads. There were 90 ventricular leads including 16 @entity1479 leads. Forty-nine (34%) leads were extracted with traction; in 96 (66%) leads a laser sheath was necessary. All leads implanted for < 6 months could be removed with traction alone. In a multivariate logistic regression model, time from implant was the main factor determining success of traction (P < 0.001), but in case of @entity281 the success rate increased (P = 0.004). In conclusion, time from implant is the decisive factor to judge the potential efficacy of lead extraction with direct traction. If leads are implanted for 6 months, the availability of additional extraction tools is necessary when lead extraction is considered. In addition to time from implant, infected leads have a better chance to be removed with traction although it is a much weaker predictor.
