Transvenous lead extraction of implantable cardioverter-defibrillators: A comprehensive outcome-and risk factor analysis
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Transvenous lead extraction of implantable cardioverter-defibrillators: A comprehensive outcome-and risk factor analysis. / Chung, Da-Un; Burger, Heiko; Kaiser, Lukas; Osswald, Brigitte; Bärsch, Volker; Nägele, Herbert; Knaut, Michael; Reichenspurner, Hermann; Gessler, Nele; Willems, Stephan; Butter, Christian; Pecha, Simon; Hakmi, Samer; GALLERY investigators.
In: PACE, Vol. 46, No. 8, 08.2023, p. 815-823.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Transvenous lead extraction of implantable cardioverter-defibrillators: A comprehensive outcome-and risk factor analysis
AU - Chung, Da-Un
AU - Burger, Heiko
AU - Kaiser, Lukas
AU - Osswald, Brigitte
AU - Bärsch, Volker
AU - Nägele, Herbert
AU - Knaut, Michael
AU - Reichenspurner, Hermann
AU - Gessler, Nele
AU - Willems, Stephan
AU - Butter, Christian
AU - Pecha, Simon
AU - Hakmi, Samer
AU - GALLERY investigators
N1 - © 2023 Wiley Periodicals LLC.
PY - 2023/8
Y1 - 2023/8
N2 - BACKGROUND: Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with 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 ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.RESULTS: We identified 842 patients with an ICD undergoing TLE with the mean age of 62.8 ± 13.8 years. A total number of 1610 leads were treated with lead dysfunction (48.5%) as leading indication for extraction, followed by device-related infection (45.4%). Lead-per-patient ratio was 1.91 ± 0.88 and 60.0% of patients had dual-coil defibrillator leads. Additional extraction tools, such as mechanical rotating dilator sheaths and snares were utilized in 6.5% of cases. Overall procedural complications occurred in 4.3% with 2.0% major complications and a procedure-related mortality of 0.8%. Clinical success rate was 97.9%. All-cause in-hospital mortality was 3.4%, with sepsis being the leading cause for mortality. Multivariate analysis revealed lead-age ≥10 years (OR:5.82, 95%CI:2.1-16.6; p = .001) as independent predictor for procedural failure. Systemic infection (OR:9.57, 95%CI:2.2-42.4; p < .001) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p < .001) were identified as risk factors for all-cause mortality.CONCLUSIONS: TLE 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.
AB - BACKGROUND: Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with 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 ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.RESULTS: We identified 842 patients with an ICD undergoing TLE with the mean age of 62.8 ± 13.8 years. A total number of 1610 leads were treated with lead dysfunction (48.5%) as leading indication for extraction, followed by device-related infection (45.4%). Lead-per-patient ratio was 1.91 ± 0.88 and 60.0% of patients had dual-coil defibrillator leads. Additional extraction tools, such as mechanical rotating dilator sheaths and snares were utilized in 6.5% of cases. Overall procedural complications occurred in 4.3% with 2.0% major complications and a procedure-related mortality of 0.8%. Clinical success rate was 97.9%. All-cause in-hospital mortality was 3.4%, with sepsis being the leading cause for mortality. Multivariate analysis revealed lead-age ≥10 years (OR:5.82, 95%CI:2.1-16.6; p = .001) as independent predictor for procedural failure. Systemic infection (OR:9.57, 95%CI:2.2-42.4; p < .001) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p < .001) were identified as risk factors for all-cause mortality.CONCLUSIONS: TLE 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.
KW - Humans
KW - Middle Aged
KW - Aged
KW - Child
KW - Defibrillators, Implantable/adverse effects
KW - Risk Factors
KW - Device Removal/adverse effects
KW - Retrospective Studies
KW - Treatment Outcome
KW - Pacemaker, Artificial/adverse effects
U2 - 10.1111/pace.14763
DO - 10.1111/pace.14763
M3 - SCORING: Journal article
C2 - 37461858
VL - 46
SP - 815
EP - 823
JO - PACE
JF - PACE
SN - 0147-8389
IS - 8
ER -
