Risk stratification of patients undergoing transvenous lead extraction with the ELECTRa Registry Outcome Score (EROS): an ESC EHRA EORP European lead extraction ConTRolled ELECTRa registry analysis

Abstract

Aims Transvenous lead extraction is associated with a significant risk of complications and identifying patients at highest risk pre-procedurally will enable interventions to be planned accordingly. We developed the ELECTRa Registry Outcome Score (EROS) and applied it to the ELECTRa registry to determine if it could appropriately risk-stratify patients. Methods and results EROS was devised to risk-stratify patients into low risk (EROS 1), intermediate risk (EROS 2), and high risk (EROS 3). This was applied to the ESC EORP European Lead Extraction ConTRolled ELECTRa registry; 57.5% EROS 1, 31.8% EROS 2, and 10.7% EROS 3. Patients with EROS 3 or 2 were significantly more likely to require powered sheaths and a femoral approach to complete procedures. Patients with EROS 3 were more likely to suffer procedure-related major complications including deaths (5.1 vs. 1.3%; P < 0.0001), both intra-procedural (3.5 vs. 0.8%; P = 0.0001) and post-procedural (1.6 vs. 0.5%; P = 0.0192). They were more likely to suffer post-procedural deaths (0.8 vs. 0.2%; P 0.0449), cardiac avulsion or tear (3.8 vs. 0.5%; P < 0.0001), and cardiovascular lesions requiring pericardiocentesis, chest tube, or surgical repair (4.6 vs. 1.0%; P < 0.0001). EROS 3 was associated with procedure-related major complications including deaths [odds ratio (OR) 3.333, 95% confidence interval (CI) 1.879–5.914; P < 0.0001] and all-cause in-hospital major complications including deaths (OR 2.339, 95% CI 1.439–3.803; P = 0.0006). Conclusion EROS successfully identified patients who were at increased risk of significant procedural complications that require urgent surgical intervention.

Long-term survival following transvenous lead extraction: Importance of indication and comorbidities

“…This is contrary to established short-term outcomes whereby longer lead dwell time is associated with increased procedure-related death. 15 In our cohort, this is likely due to younger patients with fewer CMs having longer lead dwell times (Supplemental Figure S3).…”

The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

“…Carrying out the procedure is often associated with technical problems and requires additional approaches and tools [ 22 , 23 , 24 , 25 ]. There are numerous reports on the estimation of the real risk of the TLE [ 26 , 27 , 28 , 29 ] but none of them considered LRVSO as a predictor of procedure difficulties. Among twenty reports on LRVSO [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], only three papers analyzed the occurrence of LRVSO before TLE [ 2 , 6 , 14 ], and only two considered the influence of LRVSO on procedure complexity providing at the same time conflicting results.…”

Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

“…According to recent reports, the use of a laser is associated with high efficiency also in the removal of leads with a long dwell time, although the rate of major complications remains relatively high (3.3%) [33]. If excimer laser energy is not applied, major complications other than tear of the SVC and anonymous vein seem to be more common [21][22][23][24][25][26][27]. The available guidelines and medical literature focus on cardiac/vascular wall tear but not on worsening TR after TLE [1][2][3][4][5][7][8][9][10][11].…”

“…Such knowledge is useful to plan the strategy of TLE including selection of the center, venue, first operator, organizational model (staging of safety precautions). Analysis of the well-and lesser-known factors facilitates the calculation of the real risk of major complications [23][24][25][26][27]. It also helps better prepare and provide preoperative information to the patient and family members.…”