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Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience
Sebastiaan Deckx1, Thomas Marynissen1, Filip Rega2
1Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Insights
Lead extraction is generally safe and successful for cardiac electronic devices. However, systemic infections significantly increase mortality risks, necessitating careful patient selection and management.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Management
Background:
- Increasing use of cardiac implantable electronic devices necessitates effective management of complications.
- Lead extraction is a critical but challenging procedure with inherent risks.
Purpose of the Study:
- To evaluate the 30-day and long-term outcomes of transvenous lead extractions.
- To identify risk factors associated with lead extraction complications and mortality.
Main Methods:
- Retrospective cohort study of 176 patients undergoing 295 transvenous lead extractions.
- Analysis of indications for extraction, procedural success rates, and mortality.
- Statistical analysis to identify predictors of 30-day and long-term mortality.
Main Results:
- Extraction was successful in 95.5% of patients.
- Indications included lead dysfunction (47.7%), pocket infection (34.7%), and systemic infection (17.6%).
- Systemic infection was a significant predictor of increased 30-day (19%), 1-year (32%), and long-term (39%) mortality.
Conclusions:
- Transvenous lead extraction is a safe and effective procedure for most patients.
- Systemic infection as an indication for lead extraction is associated with substantially higher mortality risks.
Aims:
Owing to the increasing use of cardiac implantable electronic devices, there is a growing need for safe and effective techniques to manage device-related complications and lead dysfunction. Lead extraction remains a challenging procedure with inherent risks. We present the 30-day and long-term outcomes of lead extractions in the University Hospitals Leuven.
Methods And Results:
We report a retrospective cohort study of 176 patients admitted to the University Hospitals Leuven between January 2005 and December 2011, for the transvenous extraction of 295 leads. Indications for extraction were lead dysfunction and device upgrade in 84 (47.7%), pocket infection in 61 (34.7%), and systemic infection in 31 patients (17.6%). Extraction was successful in 95.5% of patients with complete removal of the leads or only a minor fragment remaining. One fatal peri-procedural complication occurred. Thirty-day mortality was 3.4% (n = 6). Systemic infection was the only significant predictor of 30-day mortality [odds ratio (OR) 29.706; P = 0.029]. A lower level of haemoglobin prior to extraction also tended to be related with a higher mortality, but this was not significant (OR 2.024; P = 0.082). One-year mortality was 8.5% (n = 15). Systemic infection (OR 9.727; P = 0.009), a lower level of haemoglobin (OR 1.597; P = 0.05), and a higher level of ureum (OR 1.021; P = 0.017) prior to extraction were significant predictors of 1-year mortality. Systemic infection was associated with significantly higher 30-day (19%), 1-year (32%), and long-term (39%) mortality rates.
Conclusion:
Lead extraction can be safely and successfully performed in the majority of patients, with limited life-threatening complications. However, lead extraction because of systemic infection is associated with a significantly higher risk of short- and long-term mortality.
