Assessing long-term survival and hospitalization following transvenous lead extraction in patients with cardiac
Vishal S Mehta1,2, Hugh O'Brien2, Mark K Elliott1,2
1Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Insights
Outcomes after transvenous lead extraction (TLE) are similar for patients with and without cardiac resynchronization therapy (CRT) devices. Early reimplantation (<7 days) in CRT patients after TLE improves outcomes, highlighting the need to avoid prolonged pacing gaps.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Long-term outcomes following transvenous lead extraction (TLE) in patients with cardiac resynchronization therapy (CRT) devices remain unclear.
- Understanding these outcomes is crucial for optimizing patient management post-procedure.
Purpose of the Study:
- To compare the longer-term outcomes of patients undergoing TLE with and without CRT devices.
- To investigate the impact of reimplantation timing on outcomes in CRT patients post-TLE.
Main Methods:
- A propensity score (PS)-matched analysis was conducted on patients who underwent TLE between 2000 and 2019.
- Patients surviving to discharge and reimplanted with the same device were included, stratified by CRT device presence.
- All-cause mortality and hospitalization risks were assessed using Kaplan-Meier estimates and Cox regression.
Main Results:
- After PS matching, 192 CRT patients were compared with 192 non-CRT patients.
- No significant differences in mortality (HR=1.01) or hospitalization risk (HR=1.2) were observed between the matched CRT and non-CRT groups.
- In the matched CRT group, late reimplantation (>7 days) was associated with increased mortality (HR=1.64) and hospitalization risk (HR=1.57).
Conclusions:
- Longer-term outcomes post-TLE are comparable between CRT and non-CRT patients when matched for baseline characteristics.
- Early reimplantation (within 7 days) in CRT patients following TLE is associated with improved outcomes.
- Prolonged periods without biventricular pacing after TLE in CRT patients should be avoided to mitigate risks.
Background:
Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices.
Objectives:
A propensity score (PS)-matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed.
Methods:
Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (<7 days) or late (>7 days) reimplantation was associated with poorer outcomes.
Results:
Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00-93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74-1.39], P = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87-1.66], P = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04-2.57], P = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00-2.46], P = .049].
Conclusion:
Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.
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