Superior vena cava defibrillator coils make transvenous lead extraction more challenging and riskier.

To the Editor: Studies have demonstrated equivalent defibrillation efficacy and all-cause mortality in patients with single and dual coil implantable cardioverter-defibrillator (ICD) leads (1,2). Despite this equivalency, the vast majority of implanted ICD leads are dual coil (3). The widespread use of dual coil ICD leads is relevant to lead management because of the challenges and risks of transvenous lead extraction (TLE). Defibrillator coils enable fibrous tissue in-growth and the superior vena cava (SVC) coil is often positioned in a high-risk region and may be associated with increased difficulty and risk of TLE. The purpose of this analysis was to determine the relationship between the presence of an SVC coil and the risk of major complications and the difficulty of TLE. A retrospective analysis of patient and lead characteristics, procedural outcomes, and complications of consecutive patients undergoing ICD lead extraction at 9 high-volume centers was performed. The TLE technique has been described previously (4). Extraction time was defined as the active time for successful removal of all targeted leads from the first attempt to remove the lead to final lead removal. Difficulty of TLE was defined as the combined endpoint of the need for specialized extraction tools, namely, powered sheaths, and/or extraction time 75th percentile. Outcomes were based on the Heart Rhythm Society lead management consensus (5). Patients were followed up in-hospital, and intraprocedural outcomes are reported. Continuous variables were expressed as mean SD or median and interquartile range. Fisher exact tests were used to compare categorical variables with the exception of the complications data. Given the occurrence of zero cell data with major complications in single coil ICD leads,