Key result
End-stage renal disease in patients undergoing ICD lead extraction was associated with significantly worse 1-year survival compared to patients without ESRD (65.6% vs. 92.6%, P<0.001).
Why the study?
Does trans-venous ICD lead extraction in patients with end-stage renal disease have similar procedural outcomes and long-term survival compared to patients without ESRD?
Cohort (n=635)
No
Does trans-venous ICD lead extraction in patients with end-stage renal disease have similar procedural outcomes and long-term survival compared to patients without ESRD?
ICD lead extraction is procedurally safe and effective in ESRD patients, but long-term mortality remains substantial, largely driven by the underlying ESRD and ICD indication.
Answers are grounded in this paper and cite their sources.
Lead extraction appears safe in ESRD; leaves open whether it improves long-term survival in this high-risk group.
AIMS: End-stage renal disease (ESRD) increases the risk of implantable cardioverter-defibrillator (ICD) infection. We sought to define outcomes of lead extraction in patients with ESRD. METHODS AND RESULTS: Implantable cardioverter-defibrillator lead extractions at our institution from January 2006 to March 2014 were stratified by absence (Control-Ex, n = 465) or presence (ESRD-Ex, n = 43) of ESRD. Procedural outcomes and survival were determined by medical records review. Survival in the ESRD-Ex group was compared with a contemporaneous cohort with ESRD undergoing ICD lead implantation (ESRD-I, n = 127). Among extraction patients, those with ESRD were more likely to be extracted for infection (74.4% vs. 28.6%, P < 0.001). Extraction procedure success (Control-Ex: 97% vs. ESRD-Ex: 93%, P = 0.17) and procedural deaths (Control-Ex: 1.1% vs. ESRD-Ex: 2.3%, P = 0.413) were similar. Survival 1 year following extraction was worse in the ESRD-Ex group compared with the Control-Ex, with a survival rate of 65.6% vs. 92.6% (P < 0.001); these curves continued to diverge through year 3. One-year survival in the ESRD-Ex group was worse than among ESRD patients undergoing ICD implant (ESRD-I), but these curves converged and survival was similar by year 3. CONCLUSIONS: Implantable cardioverter-defibrillator lead extraction can be performed safely and effectively in patients with ESRD. However, despite high rates of procedural success, long-term mortality following extraction in ESRD patients is substantial. Much of the long-term mortality risk appears to be accounted for by the presence of ESRD and an indication for an ICD.
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Shah et al. (2016) conducted a cohort in End-stage renal disease and implantable cardioverter-defibrillator lead extraction (n=635). End-stage renal disease (ESRD) vs. Absence of ESRD was evaluated on 1-year survival following extraction (p=<0.001). End-stage renal disease in patients undergoing ICD lead extraction was associated with significantly worse 1-year survival compared to patients without ESRD (65.6% vs. 92.6%, P<0.001).
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