Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads

Merchant, Faisal M.; Tejada, Thor; Patel, Anamika; El-Khalil, Jad; Desai, Yaanik; Keeling, Brent; Lattouf, Omar M.; León, Angel R.; El‐Chami, Mikhael F.

doi:10.1016/j.hrthm.2018.01.018

Cited by 20 publications

(18 citation statements)

References 21 publications

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“…who found out that of 1,386 patients with infected cardiac devices 323 with previously abandoned leads required specialized extraction tools, longer fluoroscopy time, and developed more major (3.7% vs 1.4%; P = 0.009) and minor (7.7% vs 4.4%; P = 0.02) periprocedural complications . A higher rate of bailout femoral extraction and a trend toward lower clinical success (92.1%) were observed in 38 patients with abandoned leads making up 4.9% of the population of 774 patients who underwent TLE in a single center between 2007 and 2015 . Simultaneously, the available evidence shows high efficacy (complete procedural success 96.6%) and safety (major complications 1%) of prophylactic removal of noninfected leads at the time of device upgrade to avoid lead abandonment …”

Section: Discussionmentioning

confidence: 99%

To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment

Jacheć

Polewczyk

Segreti

et al. 2019

Pacing Clinical Electrophis

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Introduction:The increasing number of cardiac implantable electronic device complications represents a current problem. Abandoned leads are difficult to manage, even because indications to transvenous lead extraction (TLE) cannot be generalized. The aim of the study was to assess the late consequences of previous abandoned leads. Methods:We did a retrospective analysis of clinical data from 3,810 patients undergoing TLE in two high-volume centers (Poland and Italy) in the years 2006-2017. In order to evaluate the effects of lead abandonment, the patients were divided into a group of 582 (15.3%) subjects with abandoned leads (AL) and a group of 3,228 (84.7%) subjects with functional leads (FL). Results: Infective indications to TLE were predominant in the AL group (61.34% vs 43.4%; P < 0.001). AL was associated with a higher number of leads per patient, longer lead dwell times, more frequent venous occlusion, higher probability of intracardiac lead abrasion, and tricuspid regurgitation (P < 0.001 for all factors). The presence of AL was connected with more frequent technical complications of TLE (odds ratio [OR] 1.617; confidence interval [CI] 1.412-1.852; P = 0.000), lower procedural success rate (OR 0.270; CI 0.199-0.363; P = 0.000), and with higher mortality rate during 3.518 years of follow-up [hazard ratio 1.286; 95% CI (1.062-1.558), P = 0.010]. Conclusions: Presence of previously abandoned leads was associated with the risk of device infections, technical problems during subsequent lead extraction, dysfunction of tricuspid valve, and worse long-term outcomes. K E Y W O R D S abandoned lead, complications rate, functional lead, long-term survival, transvenous lead extraction 1006

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Section: Discussionmentioning

confidence: 99%

To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment

Jacheć

Polewczyk

Segreti

et al. 2019

Pacing Clinical Electrophis

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“…An increasing number of TLE procedure is carried out with these indications 2 and contrasting results are reported. Although the practice of abandoning leads avoids the risk of an extraction procedure, the presence of multiple leads was associated with an increased risk of infection, 3 difficulty for future extractions, [4][5][6] venous thrombosis, interference with pacing function, and tricuspid regurgitation and stenosis. 7 A recent ELECTRa sub-analysis showed that TLE in patients with abandoned leads achieved a lower success rate and an increased risk of major complications, especially when powered techniques were applied.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads

et al. 2020

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Aims Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. Methods and results Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07–11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01–1.02; P < 0.001) were associated with a higher risk of clinical failure. Conclusion Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.

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“…2,6 Abandoned leads were not an independent risk factor for extraction related complications in our study. Also, Merchant et al 9 did not find any difference in complications or mortality from lead extraction in 38 patients with compared to 736 patients without abandoned leads. In contrast, the recent published Electra data signalled more major complications, including death, in the presence of abandoned leads (3.3% vs. 1.4%).…”

Section: Discussionmentioning

confidence: 90%

“…We experienced more procedural failures of endovascular lead extraction in patients with abandoned leads. Merchant et al 9 did not find a significant difference in procedural or clinical outcome between patients with or without abandoned leads, although numbers of extractions in patients with abandoned leads were small. Notwithstanding different approaches, our results are comparable with the report of Hussein et al 3 who mainly used a laser sheath.…”

Section: Discussionmentioning

confidence: 90%

Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads

et al. 2019

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Aims Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection. Methods and results All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6–38.2) and 11.6 (5.6–17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration. Conclusion Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.

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Procedural outcomes and long-term survival associated with lead extraction in patients with abandoned leads

Cited by 20 publications

References 21 publications

To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment

To abandon or not to abandon: Late consequences of pacing and ICD lead abandonment

Safety and efficacy of transvenous mechanical lead extraction in patients with abandoned leads

Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads

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