Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

Q: What are the key findings of this study?

Repeat transvenous lead extraction occurred in 5.28% of procedures and had no significant effect on long-term mortality compared to a single extraction (HR 0.949, p=0.480).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular implantable electronic device (CIED) recipients undergoing transvenous lead extraction (TLE) (n=3654). Intervention: Repeat transvenous lead extraction (re-extraction) vs. Single transvenous lead extraction (no history of re-extraction). Primary outcome: Overall long-term mortality (HR 0.949, 95% CI 0.822-1.097, p=0.480).

Q: What does this research mean for the field?

Repeat transvenous lead extraction occurs in approximately 5.3% of procedures and does not significantly impact long-term patient mortality compared to a single extraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Andrzej Kutarski; Wojciech Jacheć; Dorota Nowosielecka; Marek Czajkowski; Łukasz Tułecki; Anna Polewczyk

doi:10.3390/ijerph192315602

November 24, 2022International Journal of Environmental Research and Public HealthOpen Access

Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

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Key result

Repeat transvenous lead extraction shows no difference in long-term mortality compared to single extraction.

HR 0.949
95% CI 0.822-1.097
P=0.480
n=3,654

Figures

Why the study?

Data regarding repeat transvenous lead extraction are scarce.

Does repeat transvenous lead extraction affect procedural safety, efficacy, and long-term mortality compared to a single extraction in patients with cardiovascular implantable electronic devices?

Key Points

To assess the frequency, predisposing predictors, procedural effectiveness, and long-term prognostic significance of repeat transvenous lead extraction.
Retrospective analysis of a single-center database comprising 3654 transvenous lead extraction procedures.
Multivariable Cox proportional hazards regression was performed to evaluate predictors of repeat extraction and long-term all-cause mortality over a mean follow-up of 1948 days.
Repeat extraction occurred in 193 procedures (5.28% of 3654 TLEs), and subsequent re-extractions occurred in 12.21% of patients, with lead failure representing the most frequent cause (51.16%).
Multivariable Cox regression identified reduced repeat extraction risk with older age at first implantation (HR = 0.987; p = 0.003), infection indication (HR = 0.392; p < 0.001), and complete procedural success (HR = 0.544; p = 0.034), whereas risk increased when functional leads were kept (HR = 1.405; p = 0.012) or superfluous leads were abandoned (HR = 2.370; p = 0.011).
Overall mortality during the follow-up period did not significantly differ between patients undergoing repeat extraction and those undergoing a single extraction (HR = 0.949; 95% CI, 0.822–1.097; p = 0.480).

Study Design

Type

Cohort (n=3,654)

Multicenter

Yes

Structured PICO

Does repeat transvenous lead extraction affect procedural safety, efficacy, and long-term mortality compared to a single extraction in patients with cardiovascular implantable electronic devices?

P

Population

3,654 patients with cardiovascular implantable electronic devices undergoing transvenous lead extraction (mean age 66.0 years, 38.2% female) followed for a mean of 1,948 days.

E

Exposure

Repeat transvenous lead extraction (re-extraction) using non-powered mechanical telescoping polypropylene sheaths (Byrd Dilator Sheaths) as first-line and powered mechanical sheath systems (Evolution, TightRail) or metal sheaths as second-line tools.

C

Comparator

Single transvenous lead extraction (patients without a history of re-extraction, n=3,304).

O

Outcome

Frequency and predictors of repeat transvenous lead extraction, and overall mortality during short-, mid-, and long-term follow-up (mean follow-up 1,948 days).hard clinical

Main Result

Hazard Ratio: 0.949 (95% CI 0.822–1.097)

p-value: p=0.480

Limitations

Retrospective analysis of a prospectively integrated database
Experience of three centers but performed by a single high-volume first operator
Inability to analyze in detail all re-infection cases after TLE because patients with all infected leads replaced returned to local hospitals
All procedures were performed using mechanical systems without laser-powered sheaths
Procedures were performed across three centers by the same single high-volume first operator
Incomplete capture of re-infection cases as patients with completely replaced infected systems returned to local referring hospitals
Only mechanical dilator sheaths were used (no laser or electrosurgical dissection sheaths)

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Implication

Repeat transvenous lead extraction occurs in 5.28% of TLE cases—primarily driven by lead failure and the retention of active or abandoned leads during initial extraction—and carries similar procedural success and long-term survival as initial extraction.

Abstract

Background: Data regarding repeat transvenous lead extraction (TLE) are scarce. The aim of study was to explore the frequency of repeat TLE, its safety, predisposing factors, as well as effectiveness of repeat procedures. Methods: Retrospective analysis of a large single-center database of 3654 TLEs. Results: Repeat TLE was a rare occurrence (193, i.e., 5,28% among 3654 TLEs). Subsequent re-extractions occurred in 12.21% of the patients. Lead failure was the most common cause of re-extraction (51.16%). Cox regression analysis showed that patients who were older at first implantation [HR = 0.987; p = 0.003], had infection-related TLE [HR = 0.392; p < 0.001] and complete procedural success [HR = 0.544; p = 0.034] were less likely to undergo repeat TLE. Functional leads left in place for continuous use [HR = 1.405; p = 0.012] or superfluous leads left in place (abandoned) [HR = 2.370; p = 0.011] were associated with an increased risk of undergoing a repeat procedure. Overall mortality in patients with repeat TLE and subsequent re-extraction in the entire FU period was similar to that in patients without a history of re-extraction [HR = 0.949; p = 0.480]. Conclusions: Repeat TLE was a rare occurrence (5.28%) among TLEs. Left of both active and nonactive leads during TLE increased the risk of re-extraction. Re-extraction has no effect on the long-term mortality.

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Cite This Study

Kutarski et al. (2022) conducted a cohort in Cardiovascular implantable electronic device (CIED) recipients undergoing transvenous lead extraction (TLE) (n=3,654). Repeat transvenous lead extraction (re-extraction) vs. Single transvenous lead extraction (no history of re-extraction) was evaluated on Overall long-term mortality (HR 0.949, 95% CI 0.822-1.097, p=0.480). Repeat transvenous lead extraction occurred in 5.28% of procedures and had no significant effect on long-term mortality compared to a single extraction (HR 0.949, p=0.480).

synapsesocial.com/papers/6a75a9203c1d3f13c2dd8f98 https://doi.org/10.3390/ijerph192315602

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Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Repeat Transvenous Lead Extraction—Predictors, Effectiveness, Complications and Long-Term Prognostic Significance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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