Lead Fixation Mechanism Affects Transvenous Lead Extraction Difficulty but not Clinical Success: Data from the European Lead Extraction Controlled Registry (ELECTRa) - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Nir Levi ¹ Maria Grazia Bongiorni ² Moshe Rav-Acha ¹ Oholi Tovia-Brodie ¹ Michael Ilan ¹ Eyal Nof ³ Charles E. H. Kennergren ⁴ Christophe Leclercq ⁵ Michael Glikson ¹ Yoav Michowitz ¹

¹Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Israel
²Department of Cardiology, Azienda Ospedaliero-Universitaria, Italy
³Leviev Heart Institute, Sheba Medical Center, Israel
⁴Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sweden
⁵Department of Cardiology, CHU Rennes, France

Background: The literature comparing transvenous lead extraction (TLE) of active (AFix) and passive (PFix) fixation leads is limited and not conclusive.

Objective: To provide characterizations of the TLE population who has AFix compared to PFix leads, and to compare according to Fix mechanism the safety and ease of extracting RA and RV leads.

Methods: The ELECTRa was analyzed. Patients were divided based on Fix mechanism into AFix-only, PFix-only, and combined Fix groups. At the lead level, outcomes defined as difficult extraction, radiological and clinical success. A multivariate logistic regression model was used to analyze the independent effect of Fix mechanism on these 3 outcomes.

Results: After excluding 659 patients with either no data on Fix mechanism, more than 1 RA or RV lead or lead location in alternative sites, the final cohort included 2815 patients [1456 (51.7%) with AFix-only leads, 982 (34.9%) with PFix-only leads and 377 (13.4%) with combined Fix leads]. At TLE, patients with AFix leads were younger with lower lead dwelling time. Age at initial implantation was similar between AFix and PFix groups. Infection was the leading cause for TLE among the combined Fix group with the lowest rates among the AFix group. Overall, there were 1689 RA (1046 AFix, 643 PFix) and 2617 RV leads (1441 AFix, 1176 PFix). The multivariate model demonstrated that PFix is independently associated with more difficult extraction for both RA and RV leads, lower radiological success only in the RA, however, it was not associated with clinical success in either location.

Conclusion: A practice shift for higher use of AFix leads is demonstrated. Fix mechanisms impact the ease of TLE of RA and RV leads, and rates of radiological success only in the RA but have no effect on clinical success. These findings should be considered during implantation and TLE procedures.