| Description |
- Background: Conduction system pacing (CSP), often accomplished with lumenless pacing leads, is increasingly employed to achieve physiologic ventricular activation. Extraction of CSP leads has raised concerns about damage to the conduction system, lead fragmentation, worsening tricuspid regurgitation (TR), and the viability of CSP reimplantation. There are limited data on extraction of these leads. The objective of this study was to describe the safety and efficacy of extraction of CSP pacing leads and compare outcomes with extraction of non-CSP lumenless leads.
Methods: In this retrospective, observational study, patients who underwent CSP/non-CSP lumenless lead removal at a large tertiary care center between 2013 and 2024 were included. Outcomes of interest included rates of complete procedural success, complications including new conduction system deficits, intraoperative lead fragmentation, and successful reimplantation. TR was assessed before and after extraction with intraprocedural transesophageal echocardiography. Data were analyzed with descriptive statistics.
Results: Overall, 23 patients were included (n=14 with CSP and n=9 with non-CSP lumenless leads implanted in the right atrium, right ventricle, or septum). The mean patient age was 52.7 ± 24.0 years, 30% were female, and the mean lead age was 4.5 ± 4.4 years. The complete procedural success rate was 100%. One serious vascular laceration complication occurred in the non-CSP group but was unrelated to the lead of interest. No new conduction system deficits were observed following extraction, and there were no cases of intraoperative lead fragmentation. Of 19 patients with CSP or 3830 leads passing through the tricuspid valve, three patients (16%) exhibited worsened TR after extraction. Manual traction alone was successful in 57% of CSP cases (mean lead age 2.4 ± 1.7 years) and in 11% of non-CSP cases (mean lead age 7.9 ± 5.3 years). Laser sheaths were used in 43% of CSP cases and 89% of non-CSP cases; rotational cutting tools were used in no CSP cases and in 33% of non-CSP cases. Reimplantation in the conduction system was attempted with a left bundle branch pacing lead and successful in 80% (n=4/5).
Conclusions: Extraction of CSP and non-CSP lumenless leads is feasible with a high success rate and a good safety profile. CSP reimplantation after extraction is also feasible with good electrical performance.
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