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Long-term survival following transvenous lead extraction: Importance of indication and comorbidities
Vishal S Mehta1, Mark K Elliott1, Baldeep S Sidhu1
1Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.
Insights
Long-term survival after transvenous lead extraction (TLE) remains a concern, with higher mortality observed in patients with infections. Older age, reduced kidney function, and comorbidities significantly increase mortality risk following TLE.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Long-term outcomes following transvenous lead extraction (TLE) are not well understood.
- Limited data exists on survival rates for patients undergoing TLE, particularly concerning extraction indications.
Purpose of the Study:
- To investigate factors influencing long-term survival in patients undergoing TLE.
- To compare survival outcomes based on whether the TLE indication was infective or noninfective.
Main Methods:
- Prospective collection of clinical data from 1151 patients undergoing TLE between 2000 and 2019.
- Patients were grouped by infective versus noninfective TLE indications.
- Multivariable analysis and Kaplan-Meier curves were used to assess mortality risk factors.
Main Results:
- Overall mortality was 34.2% over a mean follow-up of 66 months.
- Patients with infective indications had higher mortality (38.6%) compared to noninfective (28.5%).
- Increased mortality risk was associated with age >75, reduced eGFR, higher comorbidity burden, and longer lead dwell time.
Conclusions:
- Long-term mortality after TLE is substantial.
- Risk assessment for TLE should consider not only procedural complications but also longer-term survival, especially for noninfective indications.
Background:
Long-term outcomes are poorly understood, and data in patients undergoing transvenous lead extraction (TLE) are lacking.
Objective:
The purpose of this study was to evaluate factors influencing survival in patients undergoing TLE depending on extraction indication.
Methods:
Clinical data from consecutive patients undergoing TLE in the reference center between 2000 and 2019 were prospectively collected. The total cohort was divided into groups depending on whether there was an infective or noninfective indication for TLE. We evaluated the association of demographic, clinical, and device-related and procedure-related factors on mortality.
Results:
A total of 1151 patients were included. Mean follow-up was 66 months, and mortality was 34.2% (n = 392). Of these patients, 632 (54.9%) and 519 (45.1%) were for infective and noninfective indications, respectively. A higher proportion in the infection group died (38.6% vs 28.5%; P <.001). In the total cohort, multivariable analysis demonstrated increased mortality risk with age >75 years (hazard ratio [HR] 2.98; 95% confidence interval [CI] 2.35-3.78; P <.001), estimated glomerular filtration rate <60 mL/min/1.73 m2 (HR 1.67; 95% CI 1.31-2.13; P <.001), higher cumulative comorbidity (HR 1.17; 95% CI 1.09-1.26; P <.001), reduced risk per percentage increase in left ventricular ejection fraction (HR 0.98; 95% CI 0.97-0.99; P <.001), and near unity per year of additional lead dwell time (HR 0.98; 95% CI 0.96-1.00; P = .037). Kaplan-Meier survival curves demonstrated worse prognosis, with a higher number of leads extracted and increasing comorbidities.
Conclusion:
Long-term mortality for patients undergoing TLE remains high. Consensus guidelines recommend evaluating risk for major complications when determining whether to proceed with TLE. This study suggests also assessing longer-term outcomes when considering TLE in those with a high risk of medium- and long-term mortality, particularly for noninfective indications.
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