Congenital Heart And Pediatric Electrophysiology

Lead Extraction at a Pediatric/Congenital Heart Disease Center: The Importance of Patient Age at Implant.   Pham TDN, Cecchin F, O'Leary E, Fynn-Thompson F, Triedman JK, Gauvreau K, Mah DY.JACC Clin Electrophysiol. 2022 Mar;8(3):343-353. doi: 10.1016/j.jacep.2021.11.008. Epub 2022 Jan 31.PMID: 35331429   Take Home Points: This was a large contemporary single center study involving transvenous lead extraction (TLE) in 113 pediatric and congenital heart disease patients TLE was successful in 97% patients and 98% leads with 5 major complications, most commonly tricuspid valve regurgitation Risk factors for complex TLE (requiring advanced extraction tools) included younger age at implant, older lead age, RV location and multiple leads. Commentary by Dr. Jeremy Moore (Los Angeles) Congenital and Pediatric Cardiac EP section editor: Pediatric patients with cardiac implantable electronic devices may require transvenous lead extraction (TLE) due to a variety of factors that include most commonly lead dysfunction and infection. TLE in this group is not well understood, thus the present study attempted to examine the outcomes of TLE and risk factors for procedures that required specialized lead extraction equipment (“complex TLE”).   This study examined the outcomes of TLE In 113 patients and 162 leads that were classified as pediatric or congenital heart disease at a single center over a period spanning 2008 to 2019. All TLE were performed by one of 2 operators in the pediatric catheterization laboratory with surgical back up. Of the procedures, successful extraction was achieved in 110 (97%) patients and 159 (98%) leads. Overall, simple extraction was attempted in all leads and was successful in 41 leads (25%). Complex extraction was required in the remaining 120 leads (75%).   Independent risk factors for complex extraction in this study were 2leads extracted, lead location in the RV, and the combined variable of age 12 years at implant + lead age 7 years. The authors noted that of the combined variable of age at implant and lead age, lead age was the more important of the two. Interesting, extraction of a high voltage coil (associated with an ICD) was not identified as a risk factor for complex TLE in this study, likely related to the fact that age at implant and lead age were both much greater in patients with pacemaker leads as opposed to high voltage leads. There were 5 major complications that included 1) incomplete TLE resulting in operative extraction, 2) tamponade requiring urgent operative repair and 3) severe tricuspid regurgitation requiring valve repair within 6 months of the procedure in 3 patients.     The authors concluded that TLE can be performed successfully and safely in pediatric and congenital heart disease patients. Risk factors include younger age at implant, older lead age, RV location and multiple leads.