Key result
Transvenous lead extraction yields similar clinical success and mortality in ICD vs non-ICD patients.
Why the study?
Device complications necessitating transvenous lead extraction (TLE) are continuously rising in patients with indwelling transvenous ICDs, prompting this characterization of procedural outcomes and risk factors in patients with 1- and 2-chamber ICDs undergoing TLE.
Does transvenous lead extraction in patients with 1- and 2-chamber ICDs have comparable procedural outcomes and mortality compared to non-ICD patients?
Cohort (n=854)
Does transvenous lead extraction in patients with 1- and 2-chamber ICDs have comparable procedural outcomes and mortality compared to non-ICD patients?
Answers are grounded in this paper and cite their sources.
Transvenous lead extraction in 1- and 2-chamber ICD patients achieves high clinical success (97.9%) and low complication rates comparable to non-ICD patients, though systemic infection and procedural complications strongly increase mortality risk.
Funding Acknowledgements Type of funding sources: None. Background Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD). Objectives Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE. Methods We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed. Results A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p<0.001), less likely to be female (20.8 vs. 27.1%; p<0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p<0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p>0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p<0.001), followed by device-related infection (45.6 vs. 73.0%; p<0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p<0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p<0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p<0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p<0.001). Conclusions Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Chung et al. (2022) conducted a cohort in Indwelling 1- and 2-chamber implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction (TLE) (n=854). Transvenous lead extraction in 1- and 2-chamber ICD patients vs. Non-ICD patients undergoing transvenous lead extraction was evaluated on Clinical success rate (p=0.861). Transvenous lead extraction in 1- and 2-chamber ICD patients had similar clinical success (97.9% vs 97.8%, p=0.861) and mortality (3.4% vs 3.7%, p=0.742) compared to non-ICD patients.
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