Open AccessPredictors of the need for supportive femoral approach during transvenous extraction of pacemaker and defibrillator leads in Japanese patients
Author(s) -
Isawa Tsuyoshi,
Honda Taku,
Yamaya Kazuhiro,
Taguri Masataka
Publication year - 2020
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12395
Subject(s) - medicine , interquartile range , confidence interval , odds ratio , femoral vein , lead (geology) , surgery , logistic regression , receiver operating characteristic , occlusion , incidence (geometry) , area under the curve , implant , cardiology , physics , geomorphology , optics , geology
Background Studies on femoral approach during transvenous lead extraction (TLE) are limited. Methods We retrospectively evaluated 75 patients undergoing TLE from September 2014 through November 2019 via supportive femoral approach (Femoral/Superior group; n = 22) and superior approach alone (Superior group; n = 53). Results No significant between‐group differences were observed regarding patients’ baseline characteristics except for a higher incidence of access vein occlusion in the Femoral/Superior group (59.1% vs. 31.4%; P = .037). The Femoral/Superior group exhibited significantly longer dwell times of the oldest extracted lead (median: 13.4 years; interquartile range [IQR]: 8.8‐21.2 years vs. median, 7.2 years; IQR: 3.7‐10.8 years; P < .001) and a higher incidence of passive fixation ventricular pacemaker lead (81.8% vs. 39.6%; P = .001). Multivariate logistic analysis showed that access vein occlusion (odds ratio [OR]: 4.07, 95% confidence interval [CI]: 1.08‐15.3; P < .001) and dwell time of the oldest extracted lead (per year) (OR: 1.22, 95% CI: 1.09‐1.37; P = .038) were predictors of the need for supportive femoral approach. Receiver operating characteristic curve analysis revealed that 11.8 years from implant was the cutoff for the need for supportive femoral approach (sensitivity 68.2%, specificity of 81.1%, area under the curve 0.81). Conclusions Access vein occlusion and long dwell time of the oldest extracted lead predict a high probability of the need for supportive femoral approach. Supportive femoral approach may be necessary in patients with leads that are implanted for >11.8 years and whose access veins are occluded.