Background: Transvenous pacemaker and defibrillator device implant is a rapidly growing practice in pediatric and young adult congenital heart disease. The need for lead extraction is an associated eventuality in certain patients. Although several techniques have emerged in the past few years, the safety and efficacy of lead extraction in the pediatric population remains unknown. We report our experience with lead extraction using simple traction or complex extraction methods.
Methods: Retrospective cohort study of all patients having undergone a lead extraction at Children’s Hospital Boston from 2002 to 2008. Lead extraction was defined as simple if only traction was required and complex if it required the use of an interlocking stylet.
Results: A total of 114 patients underwent 124 lead extraction procedures with a total of 172 extraction attempts. The average age was 17.1 (2.47– 48.23) years at lead implant and 23.0 (6 –52.7) years at lead extraction. Congenital heart disease was present in 57.3% (71/124) of patients. Extraction by simple traction was achieved for 51 leads (mean lead age=3.1 years), while the remaining 121 leads required complex extraction (mean lead age=7.5 years), of which 32 were abandoned. Of the remaining leads 83/89 (93%) were extracted successfully. Only 2/55 (4%) leads >7.5 years of age could be extracted with simple traction. However, 63/99 (64%) leads >1 and <7.5 years of age were a complex extraction. Multivariable logistic regression analysis showed that a younger lead age (OR=0.7, 95% CI 0.6 – 0.9, P<0.01), silicone-type of lead insulation (OR=7.6, 95% CI 1.6 –36.7, P=0.01) and a lead in the atrial position (OR=3.0, 95% CI 1.1– 8.7, P=0.05) were independent predictors of a simple extraction. There was only one major complication consisting of right atrial perforation and tamponade that was controlled with surgical exploration. There was no mortality related to lead extraction procedures.
Conclusion: The majority of leads implanted in pediatric and young adult patients with congenital heart disease can be extracted successfully. Though certain lead characteristics correlated with a simple extraction procedure, the majority of leads >1 year of age will require a complex extraction technique.
Young Adult With Congenital Heart Disease Presenting With Anasarca
