Key result
Transvenous lead extraction without device reimplantation is linked to ~16% lower five-year survival versus reimplantation.
Why the study?
After transvenous lead extraction of CIEDs, some patients may not benefit from device reimplantation, but predictors and long-term outcomes of patients with vs without reimplantation required analysis.
Does transvenous lead extraction without reimplantation affect long-term survival and arrhythmia events compared to reimplantation in patients with CIEDs?
Cohort (n=223)
No
Does transvenous lead extraction without reimplantation affect long-term survival and arrhythmia events compared to reimplantation in patients with CIEDs?
Absolute Event Rate: 78.3% vs 94.7%
p-value: p=0.014
Re-evaluating the need for CIED reimplantation after extraction is safe regarding arrhythmia events, though patients without reimplantation have lower long-term survival, likely reflecting underlying comorbidities.
Supports selective reimplantation decisions after extraction; leaves open causal survival effects in this observational cohort.
Background: after transvenous lead extraction (TLE) of cardiac implantable electric devices (CIEDs), some patients may not benefit from device reimplantation. This study sought to analyse predictors and long-term outcome of patients after TLE with vs. without reimplantation in a high-volume centre. Methods: all patients undergoing TLE at our centre between January 2010 and November 2015 were included into this analysis. Results: a total of 223 patients (median age 70 years, 22.0% female) were included into the study. Cardiac resynchronization therapy-defibrillator (CRT-D) was the most common device (40.4%) followed by pacemaker (PM) (31.4%), implantable cardioverter-defibrillator (ICD) (26.9%), and cardiac resynchronization therapy-PM (CRT-P) (1.4%). TLE was performed due to infection (55.6%), malfunction (35.9%), system upgrade (6.7%) or other causes (1.8%). In 14.8%, no reimplantation was performed after TLE. At a median follow-up of 41 months, no preventable arrhythmia-related events were documented in the no-reimplantation group, but 11.8% received a new CIED after 17–84 months. While there was no difference in short-term survival, five-year survival was significantly lower in the no-reimplantation group (78.3% vs. 94.7%, p = 0.014). Conclusions: in patients undergoing TLE, a re-evaluation of the indication for reimplantation is safe and effective. Reimplantation was not related to preventable arrhythmia events, but all-cause survival was lower.
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D’Angelo et al. (2021) conducted a cohort in Patients undergoing transvenous lead extraction of cardiac implantable electric devices (n=223). Transvenous lead extraction without reimplantation vs. Transvenous lead extraction with reimplantation was evaluated on five-year survival (p=0.014). Transvenous lead extraction without device reimplantation had no preventable arrhythmia events but lower five-year survival compared to reimplantation (78.3% vs. 94.7%, p=0.014).
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