Procedural outcomes and predictors of lead extraction requiring a bailout femoral approach from a prospective registry at a large volume US center.

Background: Transvenous lead extraction (TLE) remains a complex procedure most commonly performed via the superior approach using the initial implant vein. The femoral approach is typically used as a "bailout" strategy aiming to increase success rate.

Objective: The study aimed to evaluate the procedural outcomes and factors associated with the "bailout" femoral approach in TLE.

Methods: In a prospectively maintained registry, we included all patients undergoing TLE at our center between 1996 and 2022. Patients were categorized into 2 groups: superior approach alone vs superior with a femoral bailout approach. Procedural outcomes and safety were compared between the groups.

Results: Among 4989 patients undergoing TLE, we identified 163 patients (3.3%) requiring a "bailout" femoral approach. These patients had a longer combined age of leads (26.02 ± 20.31 vs 13.68 ± 13.37 years, P < .001), older age of oldest lead (12.60 ± 8.15 vs 7.27 ± 5.80 years, P < .001), and a greater total number of targeted leads for TLE (2.66 ± 1.06 vs 2.05 ± 0.89, P < .001). Infection was more likely to be the indication for extraction in the femoral group (54.6% vs 39.9%, P < .001). By adding the femoral workstation, the cumulative clinical success increased from 96.4% to 99.1%, whereas the procedural success from 94.6% to 97.3%, despite lower success rates within the femoral group itself. No significant differences were observed in the rates of major (3.1% vs 2.8%, P = .83) or minor complications (3.7% vs 2.9%, P = .54) between the groups.

Conclusion: The "bailout" femoral approach in TLE enabled complete extraction of leads in a large proportion of patients undergoing TLE with a similar safety profile compared with the superior-only approach, despite more complex procedures.