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Lead extraction outcomes in patients with congenital heart disease
Erin A Fender1, Ammar M Killu1, Bryan C Cannon1
1Mayo Clinic, St. Mary's Campus, Mail Code RO MB 04 506CAR, 1216 2nd St SW, Rochester, MN 55902, USA.
Insights
Transvenous lead extraction is safe for patients with congenital heart disease (CHD). Despite complex cardiac histories, extraction outcomes in CHD patients are comparable to controls, with similar complication rates.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Patients with congenital heart disease (CHD) face higher risks of intracardiac device issues, including malfunction and infection, often requiring lead extraction.
- The safety profile and specific risks associated with lead extraction in this complex patient population remain incompletely understood.
Purpose of the Study:
- To evaluate the safety and outcomes of transvenous lead extraction in patients with CHD.
- To compare extraction risks and success rates in CHD patients versus a matched control group.
Main Methods:
- A retrospective study comparing 40 CHD patients with 80 matched controls who underwent transvenous lead extraction between 2001 and 2014.
- Analysis included lead characteristics, patient demographics, surgical history, extraction techniques, and complication rates.
Main Results:
- CHD patients frequently had prior cardiac surgeries (90%) compared to controls (21%).
- Complete extraction was achieved in 94% of both CHD patients and controls.
- No significant differences in complication rates were observed between the groups, despite a higher number of abandoned leads in the CHD group.
Conclusions:
- Transvenous lead extraction is a safe procedure for patients with congenital heart disease.
- The complexity and outcomes of lead extraction in CHD patients are comparable to those without CHD, even with anatomical challenges and longer implant durations.
Aims:
Patients with congenital heart disease (CHD) are at increased risk for intracardiac device malfunction and infection that may necessitate extraction; however, the risk of extraction is poorly understood. This study addresses the safety of extraction in patients with structural heart disease and previous cardiac surgery.
Methods And Results:
This retrospective study included 40 CHD and 80 matched control patients, who underwent transvenous lead extractions between 2001 and 2014. Only leads >12 months were included. There were 77 leads in CHD patients and 146 in controls. The mean age was 38 ± 16 years in CHD patients. Ninety per cent of CHD patients had ≥1 cardiac surgeries when compared with 21% of controls (P < 0.001). The number of abandoned leads was significantly different (17 vs. 3, P < 0.001). Lead age was similar with an average duration of 83 ± 87 months in CHD patients and 62 ± 65 months in controls (P = 0.24). There was no significant difference in extraction techniques. Manual traction was successful in 40% of CHD patients and 47% of controls, and advanced techniques were used in 60 and 53% of CHD patients and controls, respectively. Complete extraction was achieved in 94% of the patients in both groups. There was no significant difference in complications.
Conclusion:
Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and longer implantation times, the difficulty of lead extraction in patients with CHD is comparable with controls.
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