The effect of the age at the time of targeting a lead implantation on the difficulty with the transvenous lead extraction technique

Abstract Background In transvenous lead removal procedures, the number of years since the lead implantation is an indicator of procedural difficulty and complications. However, even with the same number of years since the lead implantation, we considered the possibility that a younger age at the time of the implantation (AoI) would increase the difficulty of the procedure. Objective To elucidate the procedural difficulty in the transvenous lead extraction procedure according to the age at the time of targeting the lead implantation. Method A total of 471 consecutive transvenous lead extraction cases were analyzed. The patient AoI of the oldest lead in extraction procedure cases was divided into two groups: those younger than 60 years (implant age <60 yrs old: AoI<60) and those older than 60 years (implant age ≧60 yrs old: AoI≧60). The analysis was conducted by the number of years since the lead implantation (<10 years: group A, 10 to 20 years: group B, and >20 years: group C). Results The number of AoI<60 and AoI≧60 patients were 60 and 254 (Group A), 51 and 56 (Group B), and 41 and 9 (Group C). The patient age significantly differed among the groups between an AoI<60 and AoI≧60 (group A: 51.7 vs. 77.1; P<0.001, group B: 61.6 vs. 83.1; P<0.001, group C: 71.2 vs. 88; P<0.001). But the oldest dwell time (years) was similar for all groups (group A: 4.6 vs. 4.2; P=0.324, group B: 14.2 vs. 13.5; P=0.148, and group C: 25.7 vs. 22.6; P=0.097). The complete removal rate (group A: 97.7% vs. 98.4%; P=0.722, group B: 90.4% vs. 93.3%; P=0.567, and group C: 78.05 vs. 90.95; P=0.337) and major complication-free rate (group A: 98.8% vs. 100%; P=0.391, group B: 96.2% vs. 100%; P=0.125, and group C: 90.2% vs. 100%; P=0.281) were not statistically significant in all groups but were higher for an AoI≧60. An AoI<60 resulted in a longer procedure time (group A: 78.4 min. vs. 65.3 min.; P=0.006, group B: 96.0 min. vs. 72.3 min.; P=0.002, and group C: 100.9 min. vs. 94.8 min.; P=0.709), longer fluoroscopy time (group A: 12.0 min. vs. 10.2 min.; P=0.247, group B: 19.2 min. vs. 11.6 min.; P=0.017, and group C: 22.2 min. vs. 16.0 min.; P=0.008), and higher number of laser pulses (group A: 779.6 vs. 433.7; P=0.002, group B: 2089.6 vs. 1032.9; P=0.017, and group C: 1509.3 vs. 831.5; P=0.201) in all groups. Conclusion This study suggested that the difficulty of transvenous lead extraction procedures may increase with a younger AoI, even if the lead dwelling time is the same.