The Japanese Lead Extraction Registry (J‐ LEX ): Annual Report in 2024

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Abstract
The Japanese Heart Rhythm Society established a nationwide, mandatory, multi‐center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J‐LEX) in 2018. As of the end of 2024, a cumulative total of approximately 5400 cases has been registered across 140 participating centers since 2018. The registry includes all consecutive transvenous extractions, excluding surgical‐only cases. The indication of TLE was an infection in 54.5%, and the guideline classification was class I in 59.8% and class IIa in 21.8%. As for non‐infectious indications, TLE is performed for abandoned leads in case of lead failure or device upgrade, and for lead‐related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty with radiation therapy. In 2024, the TLE procedure was attempted on patients with a median age of 71.3 years, female in 32.7%, in the hybrid operating room in 73.3%, and in a standard OR with a C‐arm fluoroscope in 11.5%. The average implantation duration of the target leads was 8.5 years. Complete removal was achieved in 96.7% of the target leads, and clinical success in 97.3% of the patients. Perioperative complications were observed in 4.8% of the patients. Three patients died during a TLE operation, and 11 patients died in‐hospital (cardiac death in three patients and non‐cardiac death in eight patients).