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Safety of Transvenous Lead Extraction for Cardiac Implantable Device Infection
Study Questions:
What were the safety and in-hospital outcomes of transcutaneous lead extraction (TLE) associated with device-related infection (DRI) in the United States from 2003 to 2015?
Methods:
The authors analyzed data from the National (Nationwide) Inpatient Sample. The International Classification of Diseases-9th Revision-Clinical Modification coding system was used to identify hospitalizations and major adverse events.
Results:
From a total of nearly 100 million unweighted hospitalizations, there were 12,257 hospitalizations of patients with TLE associated with DRI. After implementing the weights, this number represents an estimated 59,082 patients who underwent TLE for DRI. A large majority of patients were aged >60 years, male, Caucasian, and had comorbidities. The median length of stay was 8 days. Nonfatal major complications of TLE occurred in 6.3% of the population, and the all-cause in-hospital mortality rate was 4.1%. Independent predictors of mortality were weight loss, congestive heart failure, chronic kidney disease, pericardial complications, and procedure-related pulmonary injury.
Conclusions:
These results show that the rates of complications and mortality are rather high for TLE due to DRI and identify congestive heart failure and chronic kidney disease as significant predictors of mortality.
Perspective:
The current study suggests that a higher rate of complications may be occurring in the ‘real-world’ setting than was previously reported in extraction registries from highly selected centers. This may be in part due to the selective nature of the clinical trials and registries, which tend to attract high-volume centers. Additionally, the current study describes a patient population undergoing extraction exclusively for device-related infection, which may be older and sicker. The present analysis did not provide a breakdown of the types of devices extracted and their relationship to complication rates. Future efforts should focus on further identifying patients at highest risk and implementing strategies to make the extraction procedure safer.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Defibrillators, Implantable, Device Removal, Geriatrics, Heart Failure, Hospital Mortality, Infections, Inpatients, Kidney Diseases, Length of Stay, Lung Injury, Outcome Assessment, Health Care, Renal Insufficiency, Chronic, Secondary Prevention, Weight Loss
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