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Long-term outcomes of abandoned leads of cardiac implantable electronic devices
Soonil Kwon1, Euijae Lee2, Eue-Keun Choi3
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Long-term outcomes for abandoned leads (ALs) in cardiac implantable electronic devices (CIEDs) show single ALs pose similar risks to no ALs. However, multiple ALs significantly increase risks of infection and all-cause mortality in CIED patients.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Long-term outcomes of abandoned leads (ALs) in patients with cardiac implantable electronic devices (CIEDs) are not well-documented.
- Understanding these outcomes is crucial for managing patients with CIEDs.
Purpose of the Study:
- To investigate the long-term clinical outcomes associated with abandoned leads in patients with CIEDs.
- To compare the risks of CIED-related infection, venous thrombosis/stenosis, and all-cause mortality between patients with and without ALs.
Main Methods:
- Retrospective cohort study of 2962 CIED procedures from 1984-2018.
- 130 patients with ALs were matched with 260 controls without ALs.
- Cox proportional hazard models were used to compare outcomes.
Main Results:
- Mean follow-up was 11.2 years.
- Lead malfunction was the most common reason for abandonment (64.6%).
- While single ALs showed no significant difference in risks, multiple ALs were associated with increased risks of infection (aHR 8.61) and all-cause mortality (aHR 2.42).
Conclusions:
- Single abandoned leads (ALs) in cardiac implantable electronic devices (CIEDs) do not appear to increase long-term risks of infection, venous thrombosis/stenosis, or all-cause mortality compared to no ALs.
- Multiple ALs are associated with significantly higher risks of CIED-related infection and all-cause mortality.
Background:
Evidence of the long-term outcomes of abandoned leads (ALs) in patients with cardiac implantable electronic devices (CIEDs) is scarce.
Objective:
This study aimed to investigate the long-term outcomes of ALs.
Methods:
This retrospective cohort study reviewed a single-center CIED registry of 2962 procedures performed from 1984-2018 and identified 130 patients with AL (AL group). We matched 2 controls without AL (by age, sex, device type, and device revision/removal date) to each patient with AL (n = 260) and compared CIED-related infection, venous thrombosis/stenosis, and all-cause mortality between groups using a Cox proportional hazard model analysis.
Results:
For a mean follow-up period of 11.2 ± 8.2 years, 14 (3.6%), 7 (1.8%), and 143 (36.7%) patients had a CIED-related infection, venous thrombosis/stenosis, or experienced all-cause mortality, respectively. The AL group had more comorbidities than the control group. Lead malfunction was the most common cause of abandonment (64.6%). After adjustment for covariates, no significant intergroup differences were noted in the risks of infection, venous thrombosis/stenosis, or all-cause mortality (adjusted hazard ratio [aHR] 2.52; 95% confidence interval [CI] 0.77-8.25; aHR 1.18; 95% CI 0.25-5.64; aHR 1.26; 95% CI 0.89-1.80, respectively). Patients with multiple ALs had increased risks of infection and all-cause mortality vs controls (aHR 8.61; 95% CI 2.13-34.84; aHR 2.42; 95% CI 1.17-5.00, respectively).
Conclusion:
Patients with a single AL showed similar risks of CIED-related infections, venous thrombosis/stenosis, and all-cause mortality as those without ALs, whereas those with multiple ALs showed increased risks of infection and all-cause mortality.
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