Experience in pacemaker lead extraction: retrospective analysis of a single center

Abstract

Introduction: Therapy with implantable cardiac devices, such as pacemakers, has increased, leading to improved survival and quality of life, but also to a greater need for electrode extractions due to various complications.
Objective: To describe a single-center experience with pacemaker lead extractions from January 2017 to September 2024 and to analyze the indications, techniques used, and outcomes obtained. Primary and secondary success rates were evaluated.
Materials: A retrospective study of 40 patients (74 leads) between January 2017 and September 2024. The main indications for extraction were pocket infection (27.5%), device or lead displacement (25%), endocarditis (22.5%), device replacement or
failure (10%), and device exposure (5%). 20% of patients were referred from other institutions. The initial technique used was endovascular extraction with simple traction, or, if necessary, with sheaths.
Results: The mean age of the patients was 62.5 years; 70% were men; the most common comorbidities were hypertension (62.5%), diabetes (20%), and severe left ventricular dysfunction (32.5%). The success rate for endovascular lead extraction was 95.94%. The duration of catheter placement was shorter with simple traction (23.6 months) than with complex techniques (100.9 months), with a significant difference (p = 0.0019). Three patients required sternotomy for complete removal. The overall success rate (endovascular and sternotomy) was 100%.
Conclusion: The main cause of extraction was infection. Simple traction was effective for catheters with shorter dwell times; more complex techniques, including sheaths and sternotomy, were reserved for more difficult cases.