Predictors of mortality and outcomes in transvenous lead extraction for systemic and local infection cohorts

Abstract

Background Transvenous lead extraction (TLE) may be necessary due to infective and noninfective indications. We aim to identify predictors of 30‐day mortality and risk factors between infective versus noninfective groups and systemic versus local infection subgroups. Methods A total of 925 TLEs between October 2000 and December 2016 were prospectively collected and dichotomized (infective group n = 505 vs noninfective group n = 420 and systemic infection n = 164 vs local infection n = 341). Results All‐cause major complication including deaths was significantly higher (5.1%, n = 26 vs 1.2%, n = 5, P = 0.001) as well as 30‐day mortality (4.0%, n = 20 vs 0.2%, n = 1, P < 0.001) in the infective group compared to the noninfective group. Both subgroups (systemic vs local infection) were balanced for demographics. All‐cause major complication including deaths was significantly higher (9.1%, n = 15 vs 3.2%, n = 11, P = 0.008) as well as all‐cause 30‐day mortality (7.9%, n = 13 vs 2.1%, n = 7, P = 0.003) in the systemic infection subgroup compared to the local infection subgroup. Conclusion Patients undergoing TLE for infective indications are at greater risk of 30‐day all‐cause mortality compared to noninfective patients. Patients undergoing TLE for systemic infective indications are at greater risk of 30‐day all‐cause mortality compared to patients with local infection. Renal impairment, systemic infection, and elevated preprocedure C‐reactive protein are independent predictors of 30‐day all‐cause mortality in patients undergoing TLE for an infective indication.

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

“…Procedures were performed by the same six experienced operators in a cardiac catheter laboratory, hybrid laboratory, or operating room with immediate onsite cardiothoracic surgical cover as previously described . The majority of TLEs were undertaken in the cardiac catheterization laboratory with informal surgical cover.…”

“…Procedures were performed by the same six experienced operators in a cardiac catheter laboratory, hybrid laboratory, or operating room with immediate onsite cardiothoracic surgical cover as previously described. [10][11][12][13][14]…”

Thrombocytopenia and end stage renal disease are key predictors of survival in patients with cardiac implantable electronic device infections

“…In our cohort within the first 30 days 10 patients died of sepsis, two died of arrhythmia, and two of cardiogenic shock. Gould et al similarly report that most early mortality is related to sepsis. Patients which died within the first 30 days after treatment all suffered from CIEDR‐IE making CIEDR‐IE a significant predictor of 30‐day mortality.…”

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

“…TLEs were performed by experienced operators in a cardiac catheter laboratory, hybrid cardiac theatre or cardiac theatre with immediate onsite cardiothoracic surgical cover. Our extraction methods have been detailed previously 4 6…”

“…A growing number of cardiac implantable electronic devices (CIEDs) are implanted due to ageing populations, increased global healthcare spending and expanding CIED indications,1 with a subsequent rise in the number of CIED complications2–4 and corresponding greater need for transvenous lead extraction (TLE) procedures 5 6. Globally, approximately 10 000–15 000 leads are extracted each year for CIED infections and/or lead malfunction,3 7 and TLE is considered the first-line approach 8.…”