Impact of right ventricular lead position on the outcomes of transvenous lead extraction

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Transvenous lead extraction of apically positioned right ventricular (RV) leads could be more challenging compared to septal leads, however there is no scientific evidence regarding this issue. The aim of this study was to evaluate the impact of the RV lead position on extraction outcomes. METHODS: Data from consecutive patients undergoing transvenous lead extraction between 2014 and 2022 were retrospectively analysed. Extracted RV leads were divided into apical and non-apical groups, according to the preoperative chest X-ray images. Complete success rate of lead extraction was compared between the two groups. RESULTS: A total of 197 patients (mean age 65±14 years, 73,6% male, mean EF 50%) underwent transvenous lead extraction of 408 leads due to pocket infection (n=132, 67%), endocarditis (n=40, 20%), or non-infectious indications (n=25, 13%). 218/408 (53%) leads were right ventricular, of which 142 (65%) were extracted from an apical and 42 (19%) from a non-apical position, respectively. 34 cases (16%) with RV leads in both locations or RV leads previously pulled back from the right ventricle were excluded. There was no significant difference in the ratio of ICD leads or dual-coils between the two groups, however apical electrodes were older and had more frequently passive fixation compared to non-apical RV leads. Locking stylets, powered sheaths or snare technique were used in 88%, 82% and 30%, respectively, without any significant difference between the two groups. The complete success rate of lead extraction was higher in the non-apical group compared to apical leads (97,7% vs. 83,2%) (Odds Ratio (OR) 0,12; 95% CI 0,16-0,92; p=0,04). After adjustment for typical risk factors of extraction failure (i.e. age of leads, ICD leads, dual-coils, passive fixation) the difference become non-significant (adjusted OR 0,24; 95% CI 0,03-2,08; p=0,19). CONCLUSION: In this single-centre, high-risk patient cohort we found better success rate of RV lead extraction from non-apical positions compared to apical leads, without statistically significant difference on multivariate analysis. Our results are hypothesis generating, and call for further research evaluating the impact of the RV lead position on extraction outcomes with larger patient populations. [Figure: see text] [Figure: see text]