Predictors of short‐term mortality in patients undergoing a successful uncomplicated extraction procedure

Milman, Anat; Zahavi, Guy; Meitus, Amit; Kariv, Saar; Shafir, Yuval; Glikson, Michael; Luria, David; Beinart, Roy; Nof, Eyal

doi:10.1111/jce.14436

Cited by 6 publications

(13 citation statements)

References 24 publications

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“…Lead dwell times are not compared for the infectious and noninfectious groups and are not reported for the patients who did not have a complete success. While major complications are often reported in a range of 1 to 2%, 3,8 in this study, 4.2% of patients had major complications including four deaths (1.2%) 10 . All intraprocedural deaths occurred in the population with infectious indications.…”

Section: Current Studymentioning

confidence: 49%

“…Complete success was 90.8%, slightly lower than rates of 95%‐96% typically reported in other large studies 3,8,10 . Like other studies, though, the failure rate was higher in patients with noninfectious indications (8.5% vs 2%) 10 . Lead dwell times are not compared for the infectious and noninfectious groups and are not reported for the patients who did not have a complete success.…”

Section: Current Studymentioning

confidence: 67%

“…Indications for the noninfectious group included nonfunctioning leads (55.6%), venous occlusion (33.3%), need for repositioning to the contralateral side (6.3%), and others 10 . Complete success was 90.8%, slightly lower than rates of 95%‐96% typically reported in other large studies 3,8,10 . Like other studies, though, the failure rate was higher in patients with noninfectious indications (8.5% vs 2%) 10 .…”

Section: Current Studymentioning

confidence: 68%

“…Indications for TLE in the infectious group included pocket infection (47.8%) and systemic infection (52.2%). Indications for the noninfectious group included nonfunctioning leads (55.6%), venous occlusion (33.3%), need for repositioning to the contralateral side (6.3%), and others 10 . Complete success was 90.8%, slightly lower than rates of 95%‐96% typically reported in other large studies 3,8,10 .…”

Section: Current Studymentioning

confidence: 86%

“…In this issue of Journal of Cardiovascular Electrophysiology , Milman et al 10 help to shed more light on this difficult and important topic. Their study examines 371 consecutive patients from July 2010 to December 2018 undergoing TLE at a single center with a mean age of 64.9 years.…”

Section: Current Studymentioning

confidence: 99%

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Quantifying risk after transvenous lead extraction

Callahan

Martin

2020

Cardiovasc electrophysiol

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On the coattails of the incredible growth in pacemaker and implantable cardioverter-defibrillator implantation over the past decades have come a myriad of device and lead complications. Transvenous lead extraction (TLE) has become the gold standard for the management of many of these complications. Although advances in TLE tools and techniques have improved the safety of the procedure, serious complications including death can occur. Our ability to assess intraprocedural risk has improved, but much work needs to be done. Furthermore, patients with cardiovascular implantable electronic devices (CIEDs) often have other comorbidities but our understanding of how these interact to affect risk of mortality even after a successful TLE is limited. The decision to undertake the risk of TLE must take into account not just the risk of the procedure itself, but also the expected mortality following a successful procedure. Multiple risk factors for TLE complications have been wellestablished including female sex, low body mass index (BMI), history of CVA, severe left ventricular dysfunction, low platelet count, and coagulopathy. 1 Some can have a profound impact on risk of complications. Byrd et al 2 reported a 4.5-fold increased risk of major complications associated with female sex, while Brunner et al 3 reported a 2.7-fold increased risk of major complications in patients with international normalized ratio greater than 1.2. The results of the European Lead Extraction Controlled Study reported by Bongiorini et al 4 illustrated the role of experience, which can mitigate the risk of complications. In that study, a 1.7-fold increase in major, in hospital complications was seen in low vs high volume centers. Even lead type and tools used in TLE may impact the risk of complications. 5,6 Finally, some patients have poor clinical outcomes despite a successful procedure without complications. Extraction for infection is one of the most powerful predictors conferring a 5-to 9.7-fold increased risk of 1-year mortality. 3,7 Similarly, end-stage renal disease has been reported to increase risk of 30-day mortality by 4.8 folds. 3 In an effort to quantify risk, several prediction models have been developed. The IKAR score, developed by Oszczygiel et al 8 , assigns 1 point each for infective indications, age ≥56 years, and removal of a high-voltage lead and 2 points for kidney dysfunction with a glomerular filtration rate ≤ 60 mL/min/m 2 . None of the patients with an IKAR score of 0 died in follow up, while 1-year mortality for those with an IKAR score ≥4 was 94%. Brunner et al 9 used baseline clinical variables and multivariable logistic regression modeling to develop a nomogram to predict 30-day all-cause mortality after TLE. Points are assigned in the nomogram for age, BMI, hemoglobin, end-stage renal disease, ejection fraction, NYHA functional class, extraction for infection, operator experience, and extraction of a dual coil lead. Resultant scores predict 30-day mortality with a high corrected concordance index value (0.867). 2 | ...

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Section: Current Studymentioning

confidence: 49%

Section: Current Studymentioning

confidence: 67%

Section: Current Studymentioning

confidence: 68%

Section: Current Studymentioning

confidence: 86%

Section: Current Studymentioning

confidence: 99%

See 3 more Smart Citations

Quantifying risk after transvenous lead extraction

Callahan

Martin

2020

Cardiovasc electrophysiol

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Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

Zsigmond

Miklós

Vida

et al. 2021

J Interv Card Electrophysiol

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Purpose The use of cardiac implantable electronic devices (CIEDs) has increased significantly over the last decades. With the development of transvenous lead extraction (TLE), procedural success rates also improved; however, data regarding long-term outcomes are still limited. The aim of our study was to analyze the outcomes after TLE, including reimplantation data, all-cause and cause-specific mortality. Methods Data from consecutive patients undergoing TLE in our institution between 2012 and 2020 were retrospectively analyzed. Periprocedural, 30-day, long-term, and cause-specific mortalities were calculated. We examined the original and the revised CIED indications and survival rate of patients with or without reimplantation. Results A total of 150 patients (age 66 ± 14 years) with 308 leads (dwelling time 7.8 ± 6.3 years) underwent TLE due to pocket infection (n = 105, 70%), endocarditis (n = 35, 23%), or non-infectious indications (n = 10, 7%). All-cause mortality data were available for all patients, detailed reimplantation data in 98 cases. Procedural death rate was 2% (n = 3), 30-day mortality rate 2.6% (n = 4). During the 3.5 ± 2.4 years of follow-up, 44 patients died. Arrhythmia, as the direct cause of death, was absent. Cardiovascular cause was responsible for mortality in 25%. There was no significant survival difference between groups with or without reimplantation (p = 0.136). Conclusions Despite the high number of pocket and systemic infection and long dwelling times in our cohort, the short-and longterm mortality after TLE proved to be favorable. Moreover, survival without a new device was not worse compared to patients who underwent a reimplantation procedure. Our study underlines the importance of individual reassessment of the original CIED indication, to avoid unnecessary reimplantation.

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