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Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction
Wojciech Jacheć1, Anna Polewczyk2,3, Luca Segreti4
12nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Insights
Transvenous lead extraction (TLE) is safe and effective for elderly patients (80+ years), with similar complication rates to younger individuals. Age alone should not disqualify patients from TLE procedures.
Area of Science:
- Cardiology
- Medical Devices
- Geriatric Medicine
Background:
- Transvenous lead extraction (TLE) manages complications from pacemakers, defibrillators, and CRT devices.
- The safety of TLE in elderly patients remains a subject of debate.
Purpose of the Study:
- To evaluate the safety, effectiveness, and long-term survival of TLE in elderly patients (80+ years) compared to younger individuals.
- To identify risk factors associated with TLE in different age groups.
Main Methods:
- Retrospective analysis of 3,810 patients undergoing TLE in Poland and Italy (2006-2017).
- Patients were categorized into three groups: 30-79.99 years, 80-89.99 years (octogenarians), and ≥90 years (nonagenarians).
- Comparison of clinical characteristics, procedural outcomes, complication rates, and long-term mortality across age groups.
Main Results:
- Octogenarians and nonagenarians had more infectious indications for TLE and fewer typical risk factors compared to younger patients.
- TLE procedure duration was shorter in older patients, with similar clinical and procedural effectiveness.
- Major complication rates did not differ between octogenarians and younger subjects; nonagenarians had no major complications.
- Long-term mortality was similar in octogenarians and nonagenarians but higher than in younger patients (approx. 60% at 3 years).
Conclusions:
- TLE is effective and safe in octogenarians and nonagenarians, comparable to younger patients.
- Age itself is not a risk factor for major complications or procedural death in TLE.
- Higher numbers of prior device procedures, not age, are linked to increased TLE risk in the elderly.
Introduction:
Transvenous lead extraction (TLE) has become a frequently used tool for the management of complications related to pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices. However, it is still a matter of debate whether the lead extraction procedure is a safe treatment choice in the elderly.
Methods:
We collected the clinical information from 3,810 patients undergoing TLE in 2 high-volume centers (Poland and Italy) between 2006 and 2017. We tested risk factors, effectiveness, safety and long-term survival in 3 groups of patients: those aged 80-89.99 years, ≥90 years and 30-79.99 years.
Results:
Lower BMI, lower levels of hemoglobin and more comorbidities characterized the patients, whose ages ranged from 80 to 89.99 years. Those aged ≥90 years most often had single-chamber pacemakers. Octogenarians and nonagenarians were more often undergoing TLE due to infectious indications (57.19 and 74.29 vs. 45.35% in younger individuals). Lead age and the number of leads extracted were comparable in the 3 groups. In octogenarians, leads were more often removed using standard extraction techniques: simple traction and mechanical dilatators, whereas in nonagenarians TLE was more complex. The duration of the procedure was shorter in older patients, while clinical and procedural effectiveness was similar to that in younger individuals. The rate of major complications related to TLE did not differ between octogenarians and younger subjects (2.0 vs. 1.38%, p = ns), and the number of procedure-related risk factors was smaller in older people. Nonagenarians did not develop any major complication related to TLE. Long-term mortality after TLE was similar among octogenarians and nonagenarians (39.67 and 40.00%) but higher than in younger patients (24.41; p < 0.001 and 0.05).
Conclusions:
Lead extraction procedures appear effective and safe in octogenarians and nonagenarians, comparable to younger individuals. Procedure-related risk in the elderly is not associated with most of the typical risk factors encountered in younger subjects, but only with the higher number of pacemaker, implantable cardiac defibrillator and cardiac resynchronization therapy device procedures before TLE. Long-term survival after TLE was found to be similar among octogenarians and nonagenarians being about 60% at over 3 years of follow-up. Age alone should not be considered a risk factor for the occurrence of major complications or procedure-related death, and therefore it should not prevent candidacy for TLE.
