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Predictors of Long-Term Survival Following Transvenous Extraction of Defibrillator Leads
Faisal M Merchant1, Mathew R Levy1, Heval M Kelli2
1Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Infectious indications for implantable cardioverter defibrillator (ICD) lead extraction correlate with worse long-term survival. Lead failure extraction shows excellent survival, but procedural failure predicts mortality.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Limited data on long-term outcomes after implantable cardioverter defibrillator (ICD) lead extraction, especially for noninfectious reasons.
- Need to identify predictors of survival post-ICD lead extraction.
Purpose of the Study:
- To investigate long-term survival predictors following ICD lead extraction.
- To compare outcomes based on extraction indication (infection vs. lead failure).
Main Methods:
- Retrospective review of 508 ICD lead extractions.
- Ascertainment of procedural outcomes and long-term survival via medical records.
Main Results:
- High procedural success rate (96.5%) with low complication rate (1.6%).
- Infection as an indication for extraction was linked to significantly worse 1-year survival (88.2% vs. 95.0% for lead failure).
- Procedural failure, chronic kidney disease, number of leads extracted, and lower ejection fraction predicted mortality.
Conclusions:
- Infectious indications for ICD lead extraction are associated with increased long-term mortality.
- Excellent long-term survival observed for patients undergoing extraction due to lead failure.
- Procedural failure is a significant predictor of long-term mortality, warranting further investigation.
Background:
Little data exist on long-term outcomes following extraction of implantable cardioverter defibrillator (ICD) leads, particularly for noninfectious indications. We sought to identify predictors of long-term survival after ICD lead extraction.
Methods:
We retrospectively reviewed ICD lead extractions at our institution (n = 508). Procedural outcomes and long-term survival were ascertained by medical records review.
Results:
Indication for lead extraction was infection in 32.5% and lead failure in 61.8%. Mean dwell time of the oldest extracted lead was 5.1 ± 5.9 years. Complete procedural success was achieved in 96.5% of cases. Major procedure-related complications occurred in 1.6% with six periprocedural deaths. During a mean follow-up of 866 ± 798 days, survival was significantly worse among patients with infection as the indication for extraction. At 1 year after extraction, survival among those with infection was 88.2%, compared to 95.0% in the lead failure cohort (P < 0.001). Procedural failure was a significant predictor of long-term mortality, even after excluding periprocedural deaths. In multivariate models, the presence of chronic kidney disease, increased number of leads requiring extraction, lower ejection fraction, and procedural failure were predictors of mortality.
Conclusion:
Despite high rates of procedural success, infectious indication for ICD lead extraction is associated with increased long-term mortality. In contrast, among patients undergoing extraction for lead failure, long-term survival was excellent. The presence of procedural failure was a significant predictor of long-term mortality. Further studies will be necessary to better understand the mechanisms by which procedural failure may adversely impact long-term outcomes.
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