Background: our knowledge of lead-related venous stenosis/occlusion (LRVSO) remains limited and there is still controversy regarding the risk factors for LRVSO. Venography is mandatory before transvenous lead extraction (TLE). Methods: we performed a retrospective analysis of venograms in 2909 patients (39.43% females, average age 66.90 years) who underwent TLE between 2008 and 2021 at high-volume centers. Results: the severity of LRVSO was likely to be dependent on the number of leads in the system (OR = 1.345; p = 0.003), the number of abandoned leads (OR = 1.965; p < 0.001), the presence of coronary sinus leads (OR = 1.184; p = 0.056), male gender (OR = 1.349; p = 0.003) and patient age at first CIED implantation (OR = 1.008; p = 0.021). The presence of permanent atrial fibrillation (OR = 0.666; p < 0.001) and right ventricular diastolic diameter (OR = 0.978; p = 0.006) showed an inverse correlation with the degree of LRVSO. The combined three-model multivariate analysis provided better prediction of LRSVO using the above-mentioned factors than the CHA2DS2-VASc score. Conclusions: the severity of LRVSO is probably dependent on the mechanical impact of the implanted/abandoned leads on the vein wall, therefore the study has demonstrated the central role of system-/procedure-related risk factors. The thrombotic mechanism may be less important, especially long after implantation, and for this reason the combined prediction model for LRVSO in this study was more effective than the CHA2DS2-VASc score.

Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival.

Background: Currently, there are no reports describing lead break (LB) during transvenous lead extraction (TLE). Methods: This study conducted a retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results: Fracture of the lead, defined as LB, with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78%, and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04% of the cases studied. In cases in which the lead remnant comprises more than the tip only, there was a 50.31% chance of removing the lead fragment in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity, including long lead dwell time [OR = 1.018], a higher LV ejection fraction, multiple previous CIED-related procedures, and the extraction of passive fixation leads. The LECOM and LED scores also exhibit a high predictive value. All forms of LB were associated with increased procedure complexity and major complications (9.96 vs. 1.53%). There was no incidence of procedure-related death among such patients, and LB did not affect the survival statistics after TLE. Conclusions: LB during TLE occurs in 6.04% of procedures, and this predictable difficulty increases procedure complexity and the risk of major complications. Thus, the possibility of LB should be taken into account when planning the lead extraction strategy and its associated training.

Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.