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Embargoed until 2017-06-30
Copyright: Gomes, Sean
Embargoed until 2017-06-30
Copyright: Gomes, Sean
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Abstract
Abstract 350 words maximum: (PLEASE TYPE)
Background
Indications for cardiac implantable electronic devices (CIED’s) continue to expand. Increases in the number of devices implanted have resulted in an increased incidence of complications. These complications sometime require extraction of CIED leads for definitive treatment. I explore the indications, complications, microbiology and success rates involved with lead extraction in a high volume centre over a 20 year period. I also report long term follow up of these patients including mortality, recurrent device infection and need for repeat procedures
Methods and Results
Retrospective analysis was reported of all consecutive patients undergoing lead extraction between 1992 and 2012. 1006 leads were extracted from 510 patients. The clinical success rate was 98.2% and complete procedural success rate was 92.2%. There was one intra-procedural death. Infection was the only identified predictor of increased complication (χ² for difference between groups 20, P < 0.0001).
The mean follow up was 5.5+/-4.9 years (range 0.2 – 18 years). Cumulative mortality was 10.0% at 1 year and 33.0% at 10 years. Factors associated with increased long term mortality included cardiac device infection (CDI) (33% vs 17% for non-CDI; χ² 13.8, P = 0.0003), procedural complications (43% vs 27% for no complications; χ² 4.2, P = 0.04), age (75.0 +/- 10.9 years in patients who died vs 62.7 +/- 17.2 years, P < 0.0001) and impaired renal function (Creatinine 142.5 +/- 106.4 umol/L in patients who died vs 106.3 +/- 90.7 umol/L, P = 0.001). There was comparable mortality in those patients who did not have a replacement device after transvenous lead extraction (TLE) compared with a replacement (27 % vs 24 %, P = 0.72).
The rate of CDI after TLE was 3.9 % (mean 11.6 months post extraction, range 0.3 to 84 months) and is higher in patients with retained lead fragments (13.5% vs 3.0% % with complete removal; χ² 10.7 P = 0.001).
Conclusion
Pacing and ICD leads can be safely extracted with mechanical techniques. Long term mortality following TLE is high particularly in those with systemic infection, procedural complications, advanced age and renal impairment. Device therapy can be safely withdrawn in some patients. Finally; retained fragments are a risk factor for CDI post extraction.