Related Experiment Video
Updated: Mar 14, 2026
Author Spotlight: Advancing Endoscopic Ossiculoplasty – Techniques, Innovations, and Practical Guidance for Clinical Integration
Published on: January 26, 2024
Outcomes of lead extraction without subsequent device reimplantation
Mohammed A Al-Hijji1, Ammar M Killu1, Omid Yousefian2
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Insights
Patients undergoing cardiovascular implantable electronic device (CIED) extraction without reimplantation face significantly lower survival rates. High mortality is linked to device complications and comorbidities, not arrhythmias.
Area of Science:
- Cardiology
- Medical Devices
- Patient Outcomes
Background:
- Outcomes after cardiovascular implantable electronic device (CIED) extraction without reimplantation are not well understood.
- Understanding these outcomes is crucial for patient management and risk stratification.
Purpose of the Study:
- To investigate the outcomes of patients who do not receive device reimplantation after CIED extraction.
- To identify factors associated with mortality in this patient group.
Main Methods:
- Retrospective analysis of 678 patients undergoing CIED extraction at two medical centers (2001-2012).
- Comparison of characteristics and survival between patients with and without reimplantation.
- Kaplan-Meier survival analysis was performed.
Main Results:
- 97 patients (14%) did not undergo reimplantation, primarily because they no longer met CIED criteria (48%).
- The 'no-reimplant' group was younger but had significantly lower overall survival (60% vs. 93%).
- Increased mortality in the no-reimplant group was associated with ongoing device complications, infection, and concurrent dialysis.
Conclusions:
- A significant proportion of patients do not undergo reimplantation after CIED extraction, often because they no longer meet indications.
- Mortality in this group is high and primarily driven by device complications and comorbidities, with rare deaths attributed to arrhythmia.
Aims:
Outcomes among patients who do not receive device reimplantation after cardiovascular implantable electronic device (CIED) extraction have not been well studied. The present study aims to investigate the outcomes of patients without device reimplantation after lead extraction and device removal.
Methods And Results:
We retrospectively searched for consecutive patients who underwent CIED extraction at Mayo Clinic, Rochester, MN and University of California San Diego Medical Center from 2001 through 2012. Among the patients identified, we compared characteristics of those who did and did not have device reimplantation. The Kaplan-Meier survival was analysed. Among 678 patients, 97 patients had their device extracted without reimplantation during 1-year follow-up ('no-reimplant group'). Median age was younger in the no-reimplant group (60.7 vs. 70.6 years; P < 0.001). The reasons for no reimplantation were as follows: no longer meeting criteria for CIED (48%), inappropriate device indication at initial implantation (23%), patient preference (17%), and unresolved device complications (12%). Three major arrhythmias were reported in the no-reimplant group. Overall survival in the no-reimplant group was significantly lower than in the reimplant group (60 vs. 93%; P < 0.001). Ongoing device-related complications [hazard ratio (HR), 3.91; 95% CI, 1.74-8.81; P = 0.001], infection (HR, 3.06; 95% CI, 1.24-7.52; P = 0.02), and concurrent dialysis (HR, 2.74; 95% CI, 1.12-6.71; P = 0.03) were associated with increased mortality. Of 31 deaths in the no-reimplant group, 1 was secondary to cardiac arrhythmia.
Conclusion:
Fourteen per cent of patients who had device extraction did not undergo reimplantation mainly because they no longer met CIED indications. The high mortality in these patients is related to device complications and comorbid conditions, whereas mortality associated with arrhythmia is rare.
