Transvenous lead extraction in patients with cardiac resynchronization therapy devices is not associated with increased 30-day mortality

Gould, Justin; Kliś, Magdalena; Porter, Bradley; Sieniewicz, Benjamin; Sidhu, Baldeep S.; Claridge, Simon; Williams, Steven E.; Shetty, Anoop; O’Neill, Mark; Gill, Jaswinder; Rinaldi, Christopher Aldo

doi:10.1093/europace/euy290

Cited by 12 publications

(23 citation statements)

References 10 publications

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“…9 Previous studies also showed that sepsis (systemic infection) accounted for the majority of deaths within 30 days after TLE. [21][22][23] In our study, the multivariable analysis showed only a trend toward a higher 30 -day mortality rate in patients with LDIE in octogenarians. The stronger association of LDIE with mortality in this group in the univariable as compared with multivariable analysis (OR, 23.375; P <0.001 vs OR = 3.307; P = 0.09) showed the modifying effect of multimorbidity.…”

Section: What's New?contrasting

confidence: 62%

Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

Ząbek¹,

Boczar²,

Dębski³

et al. 2020

Polish Archives of Internal Medicine

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Section: What's New?contrasting

confidence: 62%

Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

Ząbek¹,

Boczar²,

Dębski³

et al. 2020

Polish Archives of Internal Medicine

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“…This is important as the use of femoral snaring techniques is likely to become increasingly prevalent and important in the future with the advent of leadless pacing technologies which may require such snaring techniques to allow removal. When planning procedure location, lead dwell time and number of leads requiring extraction should be taken into account in addition to older age, systemic infection indication, and renal impairment which we have previously demonstrated are independent predictors of 30‐day mortality . Currently in our institution, all prospective lead extraction cases are discussed in a multi‐disciplinary meeting involving cardiac surgeons with a risk stratification process to determine the manner and location of a TLE.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Methodsmentioning

confidence: 99%

Section: Extraction Proceduresmentioning

confidence: 99%

“…Due to the increased risk of procedure related major complications requiring an emergency thoracotomy in patients progressing to a bailout transfemoral approach, identifying these at-risk patients therefore appears critically important to facilitate better procedural planning to ensure the correct expertise are present during the procedure in order to minimize but also deal with procedure related major compli- 13 Currently in our institution, all prospective lead extraction cases are discussed in a multi-disciplinary meeting involving cardiac surgeons with a risk stratification process to determine the manner and location of a TLE.…”

Section: Clinical Importancementioning

confidence: 99%

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

Gould

Sidhu

Porter

et al. 2019

Pacing Clinical Electrophis

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Background Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P < .001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P < .001), 30‐day procedure related major complications (including deaths) (8.5% vs 1.1%, P < .001) and emergency thoracotomy rates (4.2% vs 0.7%, P = .007). All‐cause 30‐day mortality rates were similar between groups (3.4% vs 2.0%, P = .315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion Femoral approach TLE is associated with increased risk of 30‐day procedure related major complications but not 30‐day all‐cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high‐volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

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Heart failure is associated with increased risk of all‐cause mortality after transvenous lead extraction: A systematic review and meta‐analysis

Talaei

Tan

Trongtorsak

et al. 2023

Journal of Arrhythmia

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BackgroundTransvenous lead extraction (TLE) is increasingly considered in cardiac implantable electronic device management. Heart failure (HF) might be associated with mortality risks after the TLE procedure. This study aims to assess mortality risk in HF patients undergoing TLE.MethodWe searched MEDLINE and Embase databases from inception to June 2022 to identify articles that included patients with and without HF who underwent TLE, which reported mortality in both groups. The pooled effect size was calculated with a random‐effects model and 95% CI to compare post‐TLE mortality between the two groups.ResultsEleven studies were included in the analysis. Each left ventricular ejection fraction (LVEF) increased by 1% was associated with reduced mortality by 2% (HR = 0.98, 95% CI: 0.97–0.99, I2 = 74.9%, p < .01). The presence of HF compared to those without HF was associated with higher mortality rates (OR: 3.04, 95% CI: 2.56–3.61, I2 = 0.0%, p < .531). There was a significant increase in the mortality rates in patients with New York Heart Association (NYHA) function class III (OR: 2.29, 95% CI: 1.29–4.06, I2 = 0.0%, p = .498) and NYHA IV (OR: 8.5, 95% CI: 2.98–24.3, I2 = 0.0%, p = .997).ConclusionsOur study found that post‐TLE mortality decreases by 2% as LVEF increases by 1%, also mortality is higher in patients with NYHA III and IV.

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Transvenous lead extraction in patients with cardiac resynchronization therapy devices is not associated with increased 30-day mortality

Cited by 12 publications

References 10 publications

Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

Indications, procedural and early results of transvenous lead extraction in elderly patients: single-centre experience

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

Heart failure is associated with increased risk of all‐cause mortality after transvenous lead extraction: A systematic review and meta‐analysis

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