BACKGROUND: The need for transvenous lead extraction procedures of coronary sinus (CS) leads is increasing due to rising numbers of implanted cardiac resynchronization therapy devices during the past decade.
METHODS: From January 2009 to June 2013, 27 CS leads were scheduled for extraction in 27 patients (mean age (63.1±14.6) years). Indications for lead extraction were infection in 13 and lead dysfunction in 14 cases. Isolated extraction of CS leads was performed in eight, extraction of multiple leads in 19 cases. Among leads with an implant time of ≥12 months (n = 19) mean implant duration (MID) was (46.4±15.2) (12-76) months. Groups were formed depending on infectious or non-infectious indications (INF vs. Non-INF), and the use or non-use of extraction tools (ET1 vs. ET0).
RESULTS: Among patients with an implant duration of ≥12 months, complete procedural success was 94.7% and clinical success 100%. Operative mortality was zero. In the INF versus NON-INF groups complete procedural success (100% vs. 91.7%, P = 0.43), mean number of required extraction tools (0.7 (0-2) vs. 0.9 (0-3), P = 0.65) and MID (49.1±15.0 vs. 44.7±15.8, P = 0.83) did not differ significantly. Comparing the groups ET1 and ET0 showed no significant differences in complications (n = 1 vs. n = 1, P = 0.81) and MID (47.0±17.5 vs. 45.5±12.6, P = 0.71).
CONCLUSIONS: In specialized centers transvenous lead extraction of coronary sinus leads with a mean implant duration of almost four years can be performed safely and effectively. Neither non-infectious indications nor the use of extraction tools negatively affected the outcome of the procedure.