Abstract 4142758: Circumferential Tethering Of Pacemaker Leads To Bone Is Associated With Costoclavicular Intervention During Lead Extraction

Introduction/Background: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. Research Questions/Hypothesis: It is not known whether pre-procedural CT can provide information about the likelihood that a patient will require costoclavicular intervention. Goals/Aims: The purpose of this study was to determine if there are pre-procedural CT findings associated with need for intervention in the costoclavicular space during lead extraction. Methods/Approach: In this retrospective, single-center, observational study, patients who underwent lead extraction between 2013 and 2024 and required use of stiffer rotational cutting tools (TightRail Sub-C) or surgical intervention in the costoclavicular space were included. Controls who did not require costoclavicular intervention and had at least one lead with dwell time >10 years were matched to cases based on age and sex. Pre-procedural CT was evaluated for patterns of lead tethering to bone and adjacent calcification. Data were analyzed with descriptive statistics. Results/Data: Overall, 56 patients were included (n=20 Sub-C only, n=8 surgical intervention, and n=28 matched controls). The mean patient age of interventional cases was 65.0 ± 14.7 years, 18% were female, and the mean lead age was 12.3 ± 6.2 years. Four major patterns were identified on imaging: fat plane between lead and bone preserved by ≥1 mm (Sub-C intervention rate 5/24 patients, surgical intervention rate 0/24); fat plane not preserved (<1 mm) and <180° tethering of lead to bone (Sub-C 9/19, surgical 2/19); fat plane preserved with adjacent calcifications (Sub-C 2/4, surgical 1/4); and circumferential (>180°) tethering of lead to bone (Sub-C 4/9, surgical 5/9). Conclusions: Tethering of at least one lead to bone >180° was associated with a 100% rate of costoclavicular intervention and the highest rate of surgical intervention (56%). Absence of any degree of bone tethering or adjacent calcifications was associated with a 0% rate of surgical intervention. CT may be useful in pre-procedural planning for adhesions in the costoclavicular space.