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Multilevel Venous Obstruction in Patients with Cardiac Implantable Electronic Devices

Marek Czajkowski1, Anna Polewczyk2,3, Wojciech Jacheć4

  • 1Department of Cardiac Surgery, Medical University of Lublin, 20-059 Lublin, Poland.

Medicina (Kaunas, Lithuania)
|February 24, 2024
PubMed

Insights

Multilevel lead-related venous stenosis/occlusion (MLVSO) increases infectious complications and procedural difficulty during transvenous lead extraction (TLE). However, long-term survival after TLE is similar for patients with or without MLVSO.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Imaging

Background:

  • The characteristics of multilevel lead-related venous stenosis/occlusion (MLVSO) and its impact on transvenous lead extraction (TLE) outcomes are not well understood.
  • Investigating MLVSO is crucial for understanding complications and long-term prognosis in patients with cardiac implantable electronic devices (CIEDs).

Purpose of the Study:

  • To identify risk factors associated with MLVSO in patients undergoing TLE.
  • To evaluate the effectiveness of TLE procedures in patients with and without MLVSO.
  • To assess the long-term survival rates in patients with MLVSO compared to those without venous obstruction.

Main Methods:

  • Analysis of 3002 venograms performed prior to TLE procedures.
  • Identification of risk factors for MLVSO using logistic regression.
  • Comparison of procedural success rates and long-term survival between groups.

Main Results:

  • Strong predictors of MLVSO include older age at first implantation, increased number of leads, coronary sinus lead placement, bilateral chest leads, and prior lead abandonment.
  • MLVSO is associated with a higher likelihood of infectious complications and more complex TLE procedures with lower success rates.
  • Long-term survival post-TLE is comparable between patients with and without MLVSO.

Conclusions:

  • MLVSO is a significant risk factor for infectious complications in CIED patients undergoing TLE.
  • Patients with MLVSO experience more challenging TLE procedures but have similar long-term survival.
  • MLVSO provides a better measure of overall venous obstruction severity than localized narrowing.

Keywords:
complicationslong-term survivalmultilevel lead-related venous obstructionrisk factorstransvenous lead extraction

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