Extracting versus abandoning sterile pacemaker and defibrillator leads
Shasank Rijal1, Rashmee U Shah2, Samir Saba1
1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
The American Journal of Cardiology
|February 21, 2015
Summary
For nonfunctional cardiac implantable electronic device leads, lead extraction (LE) and lead capping (LC) showed similar outcomes. Operator experience and lead dwell time influenced strategy choice, not long-term results.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Nonfunctional or recalled cardiac implantable electronic device (CIED) leads require revision.
- Lead extraction (LE) and lead capping (LC) are two strategies for revision.
- Comparative outcomes and influencing factors for LE versus LC are not well-defined.
Purpose of the Study:
- To compare the outcomes of lead extraction (LE) versus lead capping (LC) for CIED lead revision.
- To identify factors influencing the choice between LE and LC strategies.
Main Methods:
- Retrospective review of patients undergoing LE (n=296) or LC (n=192) from 2006-2012.
- Exclusion of patients with infectious indications for lead removal.
- Comparison of unanticipated device-related procedures, complications, hospitalizations, and mortality using adjusted proportional hazards models.
Main Results:
- Patients undergoing LE were younger and more likely to be treated by operators with extraction experience.
- Leads removed by experienced operators had significantly longer dwell times.
- No significant difference was found in the adjusted risk of unanticipated device-related procedures between LE and LC groups (HR 1.04, 95% CI 0.62-1.75).
- Procedural complications, hospitalization rates, and all-cause mortality were similar between the two groups.
Conclusions:
- Lead revision strategy choice is influenced by operator experience and lead dwell time.
- Lead extraction and lead capping demonstrate comparable long-term outcomes for non-infectious CIED lead revision.
