Key result
In a propensity score-matched cohort, patients with cardiac resynchronization therapy devices undergoing transvenous lead extraction had no significant difference in mortality (HR 1.01) compared to those with non-CRT devices.
Why the study?
Longer-term outcomes after transvenous lead extraction in patients with cardiac resynchronization therapy devices are poorly understood.
Does the presence of a CRT device affect long-term mortality and hospitalization following transvenous lead extraction compared to non-CRT devices?
Cohort (n=1,005)
No
Does the presence of a CRT device affect long-term mortality and hospitalization following transvenous lead extraction compared to non-CRT devices?
Hazard Ratio: 1.01 (95% CI 0.74–1.39)
Absolute Event Rate: 40.1% vs 42.7%
p-value: p=0.093
Long-term outcomes post transvenous lead extraction are similarly poor in matched CRT and non-CRT patients, but delayed reimplantation (>7 days) in CRT patients is associated with increased mortality and hospitalization.
Similar post-extraction risks regardless of CRT status warrant uniform monitoring; leaves open reimplantation timing effects in observational cohorts.
Background Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices. Objectives A propensity score (PS)–matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed. Methods Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (<7 days) or late (>7 days) reimplantation was associated with poorer outcomes. Results Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00–93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74–1.39], P = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87–1.66], P = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04–2.57], P = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00–2.46], P = .049]. Conclusion Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.
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Mehta et al. (2021) conducted a cohort in Patients undergoing transvenous lead extraction (TLE) (n=1,005). Cardiac resynchronization therapy (CRT) device vs. Non-CRT device was evaluated on All-cause mortality (HR 1.01, 95% CI 0.74-1.39, p=0.093). In a propensity score-matched cohort, patients with cardiac resynchronization therapy devices undergoing transvenous lead extraction had no significant difference in mortality (HR 1.01) compared to those with non-CRT devices.
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