INTRODUCTION: Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE requiring femoral vein bailout are poorly defined. We aimed to analyze predictors and consequences of TLE requiring femoral bailout. METHODS: A single tertiary center cohort of 421 consecutive patients who underwent TLE between May 2010 and February 2020 were analyzed. Venography was routinely performed before system upgrade to identify occluded veins. Patients were divided into 2 groups according to their need for femoral bailout extraction. RESULTS: A total of 928 leads were extracted with femoral bailout approach was needed in 71 leads(7.7%) among 49 patients(11.6%). A higher proportion of right ventricular(RV) leads required femoral bailout approach compared with right atrial(RA) leads[51/499(10.2%) vs 18/326(5.5%);p=0.02]. Femoral bailout was more common among younger patients, longer lead dwell time, more pocket entries, higher number of extracted leads, presence of abandoned leads and among patients with vascular occlusion. Following multivariate analysis, presence of abandoned leads, vascular occlusion and younger age remained a significant predictor for femoral bailout. Femoral bailout resulted in higher rates of major complications [5/49(10.2%) vs 12/372(3.2%);p=0.05] without intra-procedural mortality and no additional 30-day mortality[2/49(4.1%) vs 33/377(8.8%);p=0.39]. CONCLUSION: TLE of abandoned leads, occluded veins and younger age were found to be predictors of femoral bailout requirement. Despite higher rates of major complications in femoral TLE bailout, mortality was not increased. Venography prior to TLE should be considered for procedure planning.

Introduction – We aimed to assess changes in QTc over time following cardioversion (CV) for persistent atrial fibrillation (AF), and to compare the benefit of using continuous Holter monitoring vs. conventional follow-up. Methods – The study population comprised 90 patients admitted to our center for elective CV due to persistent AF who were prospectively enrolled from July 2017 through August 2018. All patients underwent 7-day Holter started prior to CV. Baseline QTc was defined as median QTc during first hour post CV. The primary endpoint was QTc prolongation defined as QTc ≥500ms, or ≥10% increase (if baseline QTc was >480ms). Conventional monitoring was defined as an ECG recording 2-hours post CV. McNemar test was used for comparison. Results - Mean age was 67 ± 11 years and 61% were male. Median baseline QTc was 452msec (IQ range: 431-479 msec) as compared with a maximal median QTc of 474msec (IQ range: 433–527 msec; p<0.001 for the change in QTc from baseline). Peak median QTc occurred 44-hours post CV. The primary endpoint was met in 3 patients (3%) using conventional monitoring, compared with 39 new patients (43%) using Holter (p<0.001 for comparison). The Holter monitoring was superior to conventional monitoring in detecting clinically significant QTc prolongation (OR=13; p<0.001). Conclusion – CV of patients with persistent AF may be associated with increased transient risk of QTc prolongation. Peak median QTc occurs during end of second day following CV and prolonged ECG monitoring provides superior detection of significant QTc prolongation compared with conventional monitoring