Key result
The presence of abandoned leads during transvenous mechanical lead extraction was associated with a lower clinical success rate (90.4% vs 98.1%) and higher risk of clinical failure (OR 3.47).
Why the study?
Optimal management of redundant or malfunctioning leads is controversial, motivating an evaluation of the safety and efficacy of mechanical transvenous lead extraction in patients with abandoned leads.
Does mechanical transvenous lead extraction have similar safety and efficacy in patients with abandoned leads compared to those with non-abandoned leads?
Cohort (n=1,210)
No
Does mechanical transvenous lead extraction have similar safety and efficacy in patients with abandoned leads compared to those with non-abandoned leads?
Odds Ratio: 3.47 (95% CI 1.07–11.19)
Absolute Event Rate: 90.4% vs 98.1%
p-value: p=0.037
Mechanical transvenous lead extraction is safe in patients with abandoned leads, though clinical success is slightly lower compared to those without abandoned leads.
May inform extraction risk stratification; leaves open whether proactive strategies improve success in prospective studies.
AIMS: Optimal management of redundant or malfunctioning leads is controversial. We aimed to assess safety and efficacy of mechanical transvenous lead extraction (TLE) in patients with abandoned leads. METHODS AND RESULTS: Consecutive TLE procedures performed in our centre from January 2009 to December 2017 were considered. We evaluated the safety and efficacy of mechanical TLE in patients with abandoned (Group 1) compared to non-abandoned (Group 2) leads. We analysed 1210 consecutive patients that required transvenous removal of 2343 leads. Group 1 accounted for 250 patients (21%) with a total of 617 abandoned leads (26%). Group 2 comprised 960 patients (79%) with 1726 leads (74%). The total number of leads (3.0 vs. 2.0), dwelling time of the oldest lead (108.00 months vs. 60.00 months) and infectious indications for TLE were higher in Group 1. Clinical success was achieved in 1168 patients (96.5%) with a lower rate in Group 1 (90.4% vs. 98.1%; P < 0.001). Major complications occurred in only 9 patients (0.7%), without significant differences among the two groups. The presence of one or more abandoned leads [odds ratio (OR) 3.47; 95% confidence interval (CI) 1.07-11.19; P = 0.037] and dwelling time of the oldest lead (OR 1.01 for a month; 95% CI 1.01-1.02; P < 0.001) were associated with a higher risk of clinical failure. CONCLUSION: Transvenous mechanical lead extraction is a safe procedure also in high-risk settings, as patients with abandoned leads. Success rate resulted a bit lower, especially in the presence of abandoned leads with long implantation time.
No takes yet. Share an insight, caveat, or question.
Segreti et al. (2020) conducted a cohort in Redundant or malfunctioning cardiac leads (n=1,210). Presence of abandoned leads vs. Non-abandoned leads was evaluated on Clinical success / Clinical failure (OR 3.47, 95% CI 1.07-11.19, p=0.037). The presence of abandoned leads during transvenous mechanical lead extraction was associated with a lower clinical success rate (90.4% vs 98.1%) and higher risk of clinical failure (OR 3.47).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: