Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

Ząbek, Andrzej; Boczar, Krzysztof; Dębski, Maciej; Pfitzner, Roman; Ulman, Mateusz; Holcman, Katarzyna; Kostkiewicz, Magdalena; Musiał, Robert; Lelakowski, Jacek; Małecka, Barbara

doi:10.20452/pamw.15182

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…However, 30‐day mortality in our study was significantly elevated in the octogenarian group (4.9%, p = .005), and remained so when the cohorts were best matched with propensity matching analysis. This is in keeping with earlier reports 21 and is likely multifactorial. The higher rate of infection indication for TLE (60.1%, p < .01), could partly explain the raised mortality figures in this subset.…”

Section: Discussionsupporting

confidence: 93%

Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort

Akhtar

Elbatran

Starck

et al. 2021

Pacing Clinical Electrophis

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Background Cardiac implantable electronic device (CIED) therapy contributes to an improvement in morbidity and mortality across all patient demographics. Patient age is a recognized risk factor for unfavorable outcomes in invasive procedures. This is the largest series of non‐laser transvenous lead extraction (TLE) evaluating the association between patient age and procedure outcomes. Methods Data of 2205 (3849 leads) patients was collected retrospectively from six European TLE centers between January 2005–December 2018 in the PROMET study. Of these, 153 patients with 319 leads were excluded for incomplete data. A comparison of outcomes was performed between the age groups young [< 50 years], young intermediate [50–69 years], older intermediate [70–79 years], and octogenarian [≥80 years]. Results Infection was most common indication for TLE in the octogenarian cohort, less common in the younger population (60.1% vs. 33.2%, respectively, p < .01). High‐voltage leads were extracted most frequently from young patients, less frequently from octogenarians (31.6% vs. 10%, p < .001), while the opposite was evident for pacemaker leads (p < .001). Rotational sheath use was equally prevalent across all patient groups (p = .79). Minor and major complications across all the age groups were statistically similar, as was procedural success; the 30‐day mortality was most significant in the octogenarian and least in the young patients (4.9% vs. 0.4%, p = .005). Propensity matching multivariate analysis found systemic infection, lead dwell time, and patient age (p = .013, OR 1.064 [1.013–1.116]) increased risk of 30‐day mortality. Conclusion TLE is safe and effective across all age groups. 30‐day mortality risk is significantly higher in the older patients.

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Section: Discussionsupporting

confidence: 93%

Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort

Akhtar

Elbatran

Starck

et al. 2021

Pacing Clinical Electrophis

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“…The observed low rate of TLE due to infection is consistent with our strategy to rigorously treat pacing-related complications. 3 , 9 , 12 , 13 This approach aligns with the current expert consensus statement. 5 However, in other studies, especially those concerning older electrodes, the dominant indication was infectious complications.…”

Section: Discussionmentioning

confidence: 59%

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

et al. 2023

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Aims To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads with a dwell time of >10 years (Group A) vs. younger leads (Group B) using mechanical extraction systems. Methods and results Between October 2011 and July 2022, we performed TLE in 318 patients. Forty-six (14.4%) extracted ICD leads in 46 (14.5%) patients that had been implanted for >10 years. The median dwell time of all extracted ICD leads was 5.9 years. Cardiovascular implantable electronic device-related infection was an indication for TLE in 31.8% of patients. Complete ICD leads removal and complete procedural success in both groups were similar (95.7% in Group A vs. 99.6% in Group B, P = 0.056% and 95.6% in Group A vs. 99.6% in Group B, P = 0.056, respectively). We did not find a significant difference between major and minor complication rates in both groups (6.5% in Group A vs. 1.5% in Group B and 2.2% in Group A vs. 1.8% in Group B, P = 0.082, respectively). One death associated with the TLE procedure was recorded in Group B. Conclusion The TLE procedures involving the extraction of old ICD leads were effective and safe. The outcomes of ICD lead removal with a dwell time of >10 years did not differ significantly compared with younger ICD leads. However, extraction of older ICD leads required more frequent necessity for utilizing multiple extraction tools, more experience and versatility of the operator, and increased surgery costs.

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“…Similarly, study number 21 showed that infection-related devices, whether pocket infection or systemic infection, had an indication for TLE in 77.5% of the study population [ 21 ]. By contrast, Zabak et al demonstrated that infection indications of TLE represent 33.3% of the octogenarian population [ 24 ]. In study number 24, even though octogenarians have lower ejection fraction, hemoglobin levels, and kidney function along with associated comorbidities, such as CAD, atrial fibrillation, cerebrovascular diseases, and diabetes mellitus [ 24 ].…”

Section: Reviewmentioning

confidence: 99%

“…By contrast, Zabak et al demonstrated that infection indications of TLE represent 33.3% of the octogenarian population [ 24 ]. In study number 24, even though octogenarians have lower ejection fraction, hemoglobin levels, and kidney function along with associated comorbidities, such as CAD, atrial fibrillation, cerebrovascular diseases, and diabetes mellitus [ 24 ]. The proportions (98.9% and 96.7%) of the patients in study number 14 showed clinical and procedural success, respectively, which is nearly identical to that of the non-octogenarian group (Table 9 ).…”

Section: Reviewmentioning

confidence: 99%

“…Moreover, hemothorax and pocket infection were reported as minor complications [ 14 , 21 ]. Meanwhile, study number 24 identified no major complications, which illustrate that TLE is a safe procedure in the elderly regardless of all comorbidities [ 24 ]. However, we noticed that 30-day all-cause mortality was greater in octogenarians than in the younger population in our study (study number 8).…”

Section: Reviewmentioning

confidence: 99%

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Discussing the Prognosis and Complications of Transvenous Lead Extraction in Patients With Cardiac Implantable Electronic Devices (CIED): A Systematic Review

Salib,

Dardari,

Taha

et al. 2023

Cureus

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An increase in cardiovascular implantable electronic devices (CIEDs) and undoubtedly the complications brought on by these devices coincide with an increase in cardiovascular disorders, particularly heart rhythm abnormalities. The safest procedure to extract these devices is transvenous lead extraction (TLE). Thus, this systematic review aimed to summarize the possibility of success rates and the common complications that could arise during the surgery. Full-text publications in PubMed, MEDLINE, PubMed Central (PMC), and ScienceDirect were used in this study, which was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were reviewed for this systematic review after being screened by title, abstract, full-text availability, and quality appraisal assessment. Heart and vascular tears, along with tricuspid regurgitation (TR), are common adverse events. Pulmonary embolism, hemothorax, hemopericardium, and ghost appearance in echo are less common consequences. In addition, the longer the dwelling time of the leads, the greater the chance of infection due to an increase in lead adhesions and fibrous tissue that has made the procedure unsafe as time passes. However, we concluded that TLE is a successful method across all age groups with an excellent probability of clinical and procedural success in a majority of studies.

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Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

Cited by 4 publications

References 19 publications

Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort

Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort

Mechanical extraction of implantable cardioverter-defibrillator leads with a dwell time of more than 10 years: insights from a single high-volume centre

Discussing the Prognosis and Complications of Transvenous Lead Extraction in Patients With Cardiac Implantable Electronic Devices (CIED): A Systematic Review

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