• Nitesh Sood, David T Martin, Rachel Lampert, Jeptha P Curtis, Craig Parzynski, and Jude Clancy.
• From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.). soodn@southcoast.org.
• Circ Arrhythm Electrophysiol. 2018 Feb 1; 11 (2): e004768.

BackgroundTransvenous lead extraction is an integral part of management of patients with cardiovascular implantable electronic devices. Real-world incidence and predictors of perioperative complications in extractions involving implantable cardioverter-defibrillator leads have not been described in detail.Methods And ResultsData from the National Cardiovascular Data Registry Implantable Cardioverter-Defibrillator Registry were analyzed. Lead extraction was defined as removal of leads implanted for >1 year. Predictors of major perioperative complications for all extraction procedures (11 304) and for high-voltage lead (8362, 74%), across 762 centers, were analyzed using univariate and multivariate logistic regression. Major complication occurred in 258 (2.3%) extraction procedures. Of these 258 with a complication, 41 (16%) required urgent cardiac surgery. Of these 41, 14 (34%) died during surgery. Among the total 98 (0.9%) deaths reported, 18 (0.16% of total) occurred during transvenous lead extraction. In multivariable logistic regression analysis, female sex, admission other than electively for procedure, ≥3 leads extracted, longer implant duration, dislodgement of other leads, and patient's clinical status requiring lead extraction (infection/perforation) were associated with increased risk of complications. Smaller lead diameter, flat versus round coil shape, and greater proximal surface coil area were multivariate predictors of major perioperative complications specific to high-voltage leads.ConclusionsThe rate of major complications and mortality with transvenous lead extraction is similar in the real-world outcomes to that reported in recent single-center studies from high-volume centers. There is significant risk of urgent cardiac surgery, which carries a high mortality, and planning for appropriate cardiothoracic surgery backup is imperative.© 2018 American Heart Association, Inc.

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