A multicenter study presented at the Heart Rhythm Society annual meeting revealed that lead wires implanted for conduction system pacing have been largely feasible to remove. According to Dr. Pugazhendhi Vijayaraman, manual traction alone was successful in removing leads in 91% of the 341 patients involved in the study. Interestingly, leads attached to the His bundle had a removal rate of 90%, while those placed in the left bundle branch area had a slightly higher success rate of 92%. Additional extraction methods, such as mechanical extraction, laser instruments, and femoral tools, were needed in 8%, 2%, and 1% of cases respectively. Overall, 99% of the removal procedures were considered complete successes, with no permanently disabling complications or deaths reported.
Despite the high success rate in lead removal, concerns remain regarding the feasibility and safety of extracting conduction system pacing leads. The mean lead dwell time was reported to be 22 months, with even shorter durations for leads utilizing the newer left bundle branch area pacing approach. Dr. Vijayaraman cautioned that the shorter dwell time of these leads may make it challenging to predict the outcome of removing older left bundle branch area pacing leads. Lead architecture, the potential for leads to break at their septal insertion point, and damage to the tricuspid valve were highlighted as additional worries by Dr. Matthew Zipse. The unique location of these leads, along with their specific architectural design, presents a set of challenges for extraction.
The TECSPAM study included 341 patients undergoing the extraction of conduction system pacing leads, with a focus on the removal of His bundle pacing leads and left bundle branch area pacing leads. While the study yielded promising results with a low complication rate, Dr. Zipse emphasized the importance of considering the potential risks associated with older lumenless leads. He suggested that a registry for all conduction system pacing leads could provide valuable insights into failure rates, functionality, and extractability of these leads. As the technology continues to evolve, there is a need for ongoing assessment and monitoring of lead extraction procedures.
Dr. Sana Al-Khatib, the moderator of the HRS session, highlighted the expertise of the operators involved in the study, noting that they were experienced in lead extraction procedures. Dr. Vijayaraman proposed the creation of a registry to track the performance of conduction system pacing leads and assess the extractability of newer leads being introduced by the industry. The importance of ongoing surveillance and evaluation in this field cannot be overstated, as the safety and effectiveness of these pacing leads are paramount to patient outcomes.
While the removal of conduction system pacing leads has shown promising results in terms of feasibility and safety, ongoing vigilance and assessment are necessary to address potential challenges and complications associated with lead extraction. By fostering collaboration, establishing registries, and continuously evaluating new technologies, the medical community can enhance patient care and outcomes in the realm of cardiac pacing.
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