Outcomes of Transvenous Lead Removal in Patients With Prior Mediastinal Radiation
Siddharth Agarwal1, Harsh P Patel1, Zain Ul Abideen Asad2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Background:
Transvenous lead removal (TLR) in patients with a history of mediastinal radiation poses unique challenges due to potential radiation-induced fibrosis, vascular changes, and anatomical distortion, which may increase procedural complexity and complication risk. However, contemporary data on clinical outcomes in this population remain limited.
Methods:
We analyzed the National Readmissions Database (2016-2021) to identify adults (≥ 18 years) undergoing TLR. Patients were stratified by prior mediastinal radiation. Baseline characteristics were compared using standard statistical tests. Multivariable logistic regression was used to evaluate the association between prior mediastinal radiation and in-hospital outcomes, 30-day mortality, and 30-day readmissions after adjustment for demographics and comorbidities.
Results:
A total of 48,985 patients underwent TLR, of whom 735 (1.5%) had a history of mediastinal radiation. Compared with patients without radiation, those with prior radiation were older (70.1 vs. 66.2 years, p < 0.01), were more frequently females (38.2% vs. 31.6%, p < 0.01), and had higher rates of valvular heart disease, atrial fibrillation, and peripheral vascular disease. Adjusted analyses demonstrated no increased risk of in-hospital mortality (2.3% vs. 3.4%; adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.41-1.18, p = 0.29) or major complications, including cardiac arrest, pericardial complications, vascular injury, pulmonary complications, or embolic events. Similarly, (3.6% vs. 5.3%; aOR 0.76, 95% CI 0.48-1.43, p = 0.35) and 30-day all-cause readmissions (8.7% vs. 9.1%; aOR 0.81, 95% CI 0.64-1.28, p = 0.70) were not significantly different between groups. Subgroup analyses by indication for TLR (infection vs. mechanical complication) revealed no differences in outcomes.
Conclusion:
Despite theoretical concerns, prior mediastinal radiation was not associated with excess procedural risk or worse short-term outcomes after TLR. These findings may inform procedural planning and risk counseling in clinical practice.
