Safety and efficacy of cardiovascular implantable electronic device extraction in elderly patients: A meta-analysis and systematic review

BackgroundTransvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality.ObjectiveTo assess the safety and outcomes of CIED extraction in octogenarians to younger patients.MethodsWe performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts.ResultsSeven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 – 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 – 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 – 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 – 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 – 2.29, p = 0.13).ConclusionIn this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population. Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 – 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 – 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 – 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 – 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 – 2.29, p = 0.13). In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.