136-58: Risk of Collateral Lead Damage in Percutaneous Cardiac Implantable Electronic Device Extraction Free

Introduction: With the increasing numbers of Cardiac Implantable Electronic Devices (CIED), there has been an increase in the number of percutaneous device and leads extraction. In many cases, the indication for CIED removal is infection, which necessitates removal of the entire system. However, in other cases, one or several leads may be left in place if the extraction was for lead malfunction or abandoned leads. Lead-to-lead binding often occur and it is unknown how often collateral damage (defined as the need for unintended lead extraction, or loss of lead's integrity or dislodgement) occurs in the retained leads. We therefore, conducted this study to assess for collateral lead damage.

Methods: In this retrospective study, 111 patients who underwent incomplete CEID removal at the University of California San Diego from September 2010 to September 2015 were included. We established the integrity of previously functioning leads at the end of each procedure using parameters including lead impedance change ≥ 50 ohms, shock lead impedance change ≥ 3 ohms, pacing lead threshold increase ≥ 1.0 V (at a fixed pacing rate and pulse width duration of 0.4 msec), drop in signal amplitude (P wave > 50%; R wave > 25%) or presence of lead noise before and after the extraction procedure as well as on follow up visits up to a year to assess for damage to the reconnected leads.

Results: A total of 143 leads were analyzed for any collateral damage out of which, 92 were in RA, 21 were in RV and 30 were in CS. Only 4 leads, all RA leads were found to have collateral damage (2.7%). One lead had a clear insulation break on visual inspection at the end of procedure and was extracted. Others were found dislodged, had a constant noise and high pacing threshold at 1, 4.5 and 5 month follow up visit respectively. On univariate analysis, duration of lead implantation, lead's extraction site (RA versus (vs) RV vs CS) and mode of lead extraction (laser vs traction vs rotational dilator) did not have a significant correlation with collateral lead damage (P > 0.05).

Conclusion: Lead extraction can be performed safely with the right tools and technique however, there is a small risk of damaging adjacent leads. Therefore, a close follow up is needed especially for the first 6 months to assess for reconnected lead integrity.