Indications for ICD lead extraction and influence of previous generator replacement or other procedures on ICD lead survival

Abstract Background There are suggestions that subsequent ICD lead failure may be related to generator replacement. The relationship between other procedures and the need for ICD lead extraction has not been studied. Goal: to compare lead survival after primary implantation and another subsequent CIED procedures and indications for extraction. Methods Retrospective analysis of the prospectively continued TLE database (3929 procedures performed between March 2006 and July 2023 in three high-volume centers by one experienced operator). The study group consisted of 1068 patients with an ICD lead was extracted. The patients mean age was 62.13 years, (18.9% women). Result The most common cause of ICD lead removal was infection (36%), mechanical lead damage and dysfunction of intact leads were less common (34 and 21% respectively). In 54% of cases, dysfunctional lead was removed, and in 46% of cases - functional leads. The most common last procedure preceding TLE was primary implantation (56%), less common – generator replacement (27%), and other types of procedures on the CIEDS system accounted for a total of 17%. The generator replacement was associated with slightly increased risk of mechanical lead damage (electrical failure) and other following procedures are more likely to result in increased risk of infection. It seems that the main factor influencing the occurrence of need for lead extraction is the passage of time, wearing-out of lead and changes in the endocardium. Necessary operations performed on the leads during subsequent procedures play a minor role. Conclusion 1. There is a weak connection only between a successive procedure and the need for ICD lead extraction. 2. The generator replacement is associated with early mechanical lead damage and other subsequent procedures are more likely to result in infection.