PREDICTORS OF EFFECTIVENESS AND COMPLICATIONS OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES LEAD EXTRACTION IN PATIENTS WITH SYSTEMS OLDER THAN 10 YEARS

Background : Many studies have identified the risk factors of outcome of general patients population indicated for CIED extraction. Methods : Patients with IA or B indication for extraction of pacing or ICD leads  that are more than 10 years after first implant, were randomized to use either  mechanical extraction including femoral approach or a combination of mechanical extraction and excimer laser technique. The primary endpoint was the efficiency and safety of the extraction procedure.  Results : 227 patients ( 141 men , 86 women, mean age 64 ± 21 The group included 121 ICD electrodes (97 dual coil ), 89 atrial and 181 years ) were referred to the complete extraction CIEDS for sepsis with evidence of bacterial endocarditis (139 ) or defect in the PM/ICD pocket (88 ) . The average time from the first implant of the electrodes was 147 ± 29 months (the oldest 252 months ), the average number in one person were 2,3 electrodes. ventricular pacing electrodes , 17 LV leads. Average procerure time was 148 ± 41 minutes . In 114 patients we used the combination of an excimer laser (SLS II Spectranetics Corporation, USA ) and mechanical extraction ( Evolution® , Cook Medical , USA) in 113 patients we performed only mechanical extraction. Complete extraction was achieved in 212 patients ( 93%), no patient died immediately , 30-days mortality rate was 1.85% . Complications occurred in 3.48 % of patients. The most common complication were sepsis , hematoma indicated for a revision , and perforation of the right ventricle . Conclusions : Among the patiens undergoing extraction of CIED system , presence of multiple electrodes , use of mechanical lead extraction only, dual coil ICD leads , sepsis , renal failure , pulmonary circulation disordes and short- term operator experience strongly were associated with complications procedure and effectivity .