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

Mdaihly, M; Watfa, A; Younis, A; Demian, J; Callahan, TD; Motairek, I; Tabaja, C; Santangeli, P; Baranowski, B; Taigen, TL; Martin, DO; Nakhla, S; Kanj, M; Bhargava, M; Saliba, WI; Wazni, OM; Hussein, AA

doi:10.1016/j.hrthm.2025.05.061

Arrhythmias & electrophysiology

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

Heart RhythmPublished 3 Jun 2025prospectively maintained registry

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Authors' 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.

Study context

Population: Patients undergoing transvenous lead extraction (TLE) at one center between 1996 and 2022patients undergoing TLE, 163 (3.3%) required a bailout femoral approach
Participants: 4,989 patients

Exposure: Superior approach alone vs superior with a femoral bailout approach
Superior with a femoral bailout approachn = 163
Outcome: Combined age of leads

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

Superior with a femoral bailout approach26.02mean · SD 20.31 · years

Superior approach alone13.68mean · SD 13.37 · years

Observational data: associations, not effects.

Further findings

Age of oldest lead

Superior approach alonemean 7.27 yearsSD 5.80

Superior with a femoral bailout approachmean 12.60 yearsSD 8.15

Infection as the indication for extraction

Superior approach alone39.9%

Superior with a femoral bailout approach54.6%

Mean

Outcome	Superior approach alone	Superior with a femoral bailout approach
Total number of targeted leads for TLE	2.05 (SD 0.89)	2.66 (SD 1.06)

Age of oldest lead: P < .001
Total number of targeted leads for TLE: P < .001
Infection as the indication for extraction: P < .001

Cumulative clinical and procedural success by adding the femoral workstation

Cumulative clinical success increased from 96.4% to: 99.1%
Procedural success increased from 94.6% to: 97.3%
Lower success rates within the femoral group itself

Safety

Major and minor complications · No significant differences

Major complications

Superior approach alone2.8%

Superior with a femoral bailout approach3.1%

Minor complications

Superior approach alone2.9%

Superior with a femoral bailout approach3.7%

Major and minor complications: major P = .83
Major and minor complications: minor P = .54

Original publication

Procedural outcomes and predictors of lead extraction requiring a bailout femoral approach from a prospective registry at a large volume US center. Heart Rhythm. Published 3 June 2025. doi:10.1016/j.hrthm.2025.05.061

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