High mid-term mortality following successful lead extraction for infection

Transvenous lead extraction patients tend to have multiple medical problems complicated by prolonged infections that may result in high-mortality rates following a successful procedure.

All adult patients referred for lead extraction for infection over a 4-year period were included in this study. Mortality following the procedure was assessed using hospital records and the Social Security Death Index.

Indications for extraction were systemic infection (n = 34) and isolated pocket infection (n = 33). Of the 67 patients, 47 (70%) were still alive at follow-up (6-55 months). No patient died during or within 24 hours of the procedure, and two were sent to emergent surgery and did well. However, five died during prolonged hospitalizations, and two were discharged to hospice care and died shortly thereafter. The remaining 13 deaths occurred after discharge from the hospital at a mean interval of 15 months (range, 24 days to 35 months) following the procedure. Notably, six of seven patients who died in the hospital, and nine of 13 who died after discharge, had bacteremia as their indication for extraction, for an overall mortality risk of 44% in patients with systemic infection.

True risk assessment for lead extraction patients is underestimated and may be related to the focus on the procedural risks, while the underlying illness and physiologic state may account for the excess mortality following a successful extraction. In most cases, the infected hardware contributed to the length and severity of the illness, and thus earlier consideration for extraction may be warranted.