Laser Lead Extraction in the Octogenarian Patient

Abstract

Background-In the United States, patients aged Ͼ75 years are the most rapidly growing segment in the population, with an expected increase of 126% by 2050. These patients account for Ͼ70% of the pacemakers and up to two thirds of the implantable cardioverter-defibrillators implanted annually. Our aim was to explore the clinical outcomes of device complications in the octogenarian population. Methods and Results-We performed a retrospective chart review of 506 patients undergoing laser lead extraction from January 2004 to September 2009. This population was divided into the following 2 groups based solely on age: octogenarians and nonoctogenarians. These 2 groups were compared on the basis of several characteristics and clinical outcomes. There were 118 patients in the octogenarian group (78 men) and 388 in the nonoctogenarians group (301 men) aged 85Ϯ3.8 and 64.2Ϯ12.4 years, respectively. A total of 253 leads (atrial, 99; ventricular, 145; coronary sinus, 9) were removed from the patients in the octogenarian group, and 814 leads (atrial, 295; ventricular, 442; coronary sinus, 77) were removed from the patients in the nonoctogenarian group. The main indication for extraction for both groups was infection. The lead implant duration was 59.6Ϯ52.8 and 38.6Ϯ43.9 months for octogenarians and nonoctogenarians, respectively. There was no significant difference with respect to the proportion of minor (Pϭ0.65), major (Pϭ0.56), and total (Pϭ0.50) complications. Conclusions-Laser

Safety and effectiveness of transvenous lead extraction in elderly patients

“…To the best of our knowledge, this is the 5 th , and the largest study (significantly longer implant duration in the described patients also seems to be important) reporting the safety and effectiveness of TLE in octogenarians, similar to previous 4 reports [4][5][6][7], that advanced age does not affect the safety and efficacy of TLE procedures. As in previous reports, the problem of optimal management of old patients with different late pacing complications still remains controversial.…”

“…System duration in our patients expressed as mean leads body dwelling time (76.4 months in octogenarians and 83.5 months in younger adult patients) is significantly longer than in 4 cited reports [4][5][6][7].…”

“…The largest reports of Pelargonio et al [4], Rodriguez et al [6], and Williams et al [7] indicate that the majority of patient population underwent lead extraction because of device-related infection, which represents a mandatory indication for lead extraction. In contrast, 47% of our octogenarian patients were referred for TLE due to non-infective indications.…”

“…There is a considerable controversy regarding TLE safety in elderly patients due to their potentially worse general condition, more concomitant diseases and additional difficulties in sedation or analgesia. Until now, there have been 4 available reports concerning safety and effectiveness of lead extraction in elderly patients [4][5][6][7]. Octogenarians are considered poor candidates for invasive procedures including TLE because of many comorbidities.…”

Procedural outcomes and long‐term survival following lead extraction in octogenarians

“…Lead extraction (LE) is often the only effective treatment for CIED‐related infections and is sometimes needed for successful lead revision or device upgrades . A few studies have reported procedural outcomes of LE in octogenarians; however, none have reported long‐term survival among elderly individuals after LE.…”