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Long-Term Mortality Following Transvenous Lead Extraction
Study Questions:
Is survival compromised after transvenous lead extraction (TLE) in patients with cardiovascular electronic implantable devices (CEIDs)?
Methods:
This was a retrospective study of 985 patients (mean age 63 years) who underwent 1,043 TLE procedures, most commonly because of infection (50%) or lead malfunction (30%). A mean of 1.9 leads were extracted per procedure. The mean duration of follow-up was 3.4 years.
Results:
The clinical success rate of TLE was 99.4%. The major complication rate was 0.48%, with no procedure-related deaths. The cumulative mortality rate was 8.4% at 1 year, 31.4% at 5 years, and 46.8% at 10 years. By multivariate analysis, the strongest predictors of mortality were systemic infection (hazard ratio [HR], 3.5), pocket infection (HR, 2.7), and CEID upgrade (HR, 2.1 relative to TLE for lead malfunction).
Conclusions:
The authors concluded that long-term mortality is high in patients with CEIDs who undergo TLE, particularly when TLE is performed because of infection or device system upgrade.
Perspective:
Long-term mortality was high in this patient population. It seems likely that the deaths were related to age and comorbidities, not the TLE procedure itself; however, this is unclear because information on the causes of death was not available in the study. In addition, the clinical impact of TLE on long-term outcomes would have been more clear-cut had there been a control group of matched patients with CEIDs who had not undergone TLE.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias
Keywords: Defibrillators, Implantable
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