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

El‐Chami, Mikhael F.; Sayegh, Michael N.; Patel, Anamika; El-Khalil, Jad; Desai, Yaanik; León, Angel R.; Merchant, Faisal M.

doi:10.1111/pace.13113

Cited by 8 publications

(25 citation statements)

References 16 publications

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“…In our large single center analysis, the rate of clinical success was high, without significant differences between octogenarian and nonoctogenarian patients. This is in line with the literature, where a comparable success rate was found in patients treated with MD, 5 with laser extraction, 6 and with both techniques, irrespective of older age 14,15 . In the ELECTRA registry, age was not actually a predictor of clinical success 12 .…”

Section: Discussionsupporting

confidence: 88%

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Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients

Santoro

Segreti

Zucchelli

et al. 2020

Pacing Clinical Electrophis

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Background: Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods:Patients who had undergone TLE in single tertiary referral center were divided in two groups (group 1: ≥ 80 years; group 2: < 80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation.Results: Our analysis included 1316 patients (group 1: 202; group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities, more pacemakers than implantable cardioverter-defibrillators, whereas the dwelling time of the oldest lead and the number of leads were similar, irrespective of patient's age. In group 1, the radiological success rate for lead was higher (99.0% vs 95.9%; P < .001) and the fluoroscopy time lower (13.0 vs 15.0 min; P = .04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P = .36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P = .24) and with no procedure-related deaths in elderly group. Conclusions:Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure.

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Section: Discussionsupporting

confidence: 88%

“…Fu et al did not find any correlation between the age on the patient and the rate of major complications 17 . And, finally, El‐Chami et al found no significant differences in survival up to 3 years following TLE in the over‐80s 14 …”

Section: Discussionmentioning

confidence: 98%

Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients

Santoro

Segreti

Zucchelli

et al. 2020

Pacing Clinical Electrophis

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“…Lead removal is the most widely used procedure today in patients with complications related to cardiac electronic devices (pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices); however, TLE as a treatment method in the elderly still raises several questions. Age of the patient undergoing lead extraction is considered a risk factor for long-term mortality [12], although the evidence does not show an increased procedural risk in older subjects [4-9, 13]. Findings from this study corroborate previous research.…”

Section: Discussionsupporting

confidence: 80%

“…In a study of 235 patients (51 ≥80 years and 14 ≥90 years of age) undergoing TLE using laser energy there was a similar rate of major complications among octogenarians with a significantly lower BMI as compared with younger individuals (2.0 vs. 2.7%; p = 1.0) [5]. Analogically, a study of 774 patients (100 ≥80 years of age, including 9 ≥90 years of age) showed no differences in the occurrence of major complications (1.0 vs. 1.2%; p = 1.0) in elderly patients with a significantly lower body mass [4]. The current investigation did not confirm the effect of more comorbidities on the occurrence of major complications in the elderly.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction Procedures

et al. 2020

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Introduction: Transvenous lead extraction (TLE) has become a frequently used tool for the management of complications related to pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices. However, it is still a matter of debate whether the lead extraction procedure is a safe treatment choice in the elderly. Methods: We collected the clinical information from 3,810 patients undergoing TLE in 2 high-volume centers (Poland and Italy) between 2006 and 2017. We tested risk factors, effectiveness, safety and long-term survival in 3 groups of patients: those aged 80–89.99 years, ≥90 years and 30–79.99 years. Results: Lower BMI, lower levels of hemoglobin and more comorbidities characterized the patients, whose ages ranged from 80 to 89.99 years. Those aged ≥90 years most often had single-chamber pacemakers. Octogenarians and nonagenarians were more often undergoing TLE due to infectious indications (57.19 and 74.29 vs. 45.35% in younger individuals). Lead age and the number of leads extracted were comparable in the 3 groups. In octogenarians, leads were more often removed using standard extraction techniques: simple traction and mechanical dilatators, whereas in nonagenarians TLE was more complex. The duration of the procedure was shorter in older patients, while clinical and procedural effectiveness was similar to that in younger individuals. The rate of major complications related to TLE did not differ between octogenarians and younger subjects (2.0 vs. 1.38%, p = ns), and the number of procedure-related risk factors was smaller in older people. Nonagenarians did not develop any major complication related to TLE. Long-term mortality after TLE was similar among octogenarians and nonagenarians (39.67 and 40.00%) but higher than in younger patients (24.41; p < 0.001 and 0.05). Conclusions: Lead extraction procedures appear effective and safe in octogenarians and nonagenarians, comparable to younger individuals. Procedure-related risk in the elderly is not associated with most of the typical risk factors encountered in younger subjects, but only with the higher number of pacemaker, implantable cardiac defibrillator and cardiac resynchronization therapy device procedures before TLE. Long-term survival after TLE was found to be similar among octogenarians and nonagenarians being about 60% at over 3 years of follow-up. Age alone should not be considered a risk factor for the occurrence of major complications or procedure-related death, and therefore it should not prevent candidacy for TLE.

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Efficacy and safety of transvenous lead extraction in the Chinese octogenarian patients

Zhou

et al. 2021

Clinical Cardiology

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Background Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. We report the safety and effectiveness of transvenous lead extraction in Chinese octogenarian patients. Hypothesis Transvenous lead extraction can be performed safely and successfully in the Chinese octogenarians. Methods We retrospectively identified all patients who underwent TLE at our institution between March 2013 and January 2021. This population was divided into the following two groups based solely on age: octogenarians and non‐octogenarians. These two groups were compared on the basis of several characteristics and clinical outcomes. Results Consecutive 1106 patients were analyzed, including 184 (16.6%) octogenarians and 922(83.4%) non‐octogenarians. The octogenarians presented more comorbidities. A total of 378 leads and 2004 leads were removed from the patients in the octogenarian group and non‐octogenarian group, respectively. The mean lead implant duration was 6.1 ± 5.1 and 5.8 ± 4.6 years for octogenarians and non‐octogenarians (p = 0.296). The majority of the patients in both groups underwent TLE through the femoral approach (67.5% vs 61.6%, p = 0.14). The complete procedure success rate was similar between the octogenarian and non‐octogenarian group (96.7% vs.95.3%, p = 0.39). There were no differences with respect to the proportion of minor, major complications and deaths. Long‐term mortality (median time 3.3 years) after TLE in octogenarians was significantly higher compared with younger individuals. Conclusions At experienced centers, transvenous lead extraction can be performed safely in Chinese octogenarians with procedural success rate and complication rate comparable to younger individuals.

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

Abstract: At experienced centers, LE can be performed safely in octogenarians with procedural success rates and long-term survival comparable to younger individuals.

Cited by 8 publications

References 16 publications

Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients

Transvenous lead extraction: Efficacy and safety of the procedure in octogenarian patients

Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction Procedures

Efficacy and safety of transvenous lead extraction in the Chinese octogenarian patients

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