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Pacemaker and Defibrillator Lead Extraction: Predictors of Mortality during Follow‐Up
Author(s) -
HAMID SHOAIB,
ARUJUNA ARUNA,
GINKS MATTHEW,
McPHAIL MARK,
PATEL NIKHIL,
BUCKNALL CLIFF,
RINALDI CHRISTOPHER
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02601.x
Subject(s) - medicine , sepsis , endocarditis , surgery , etiology , implant , logistic regression , implantable cardioverter defibrillator , thrombosis , lead (geology) , cardiology , geomorphology , geology
Background:Extraction of cardiac implantable electric devices is an accepted procedure when systems become infected or malfunction. However, there is an associated morbidity and mortality. We report our 5‐year experience and identify predictors of mortality, and long‐term follow‐up.Methods:We analyzed extraction data from January 2003 to November 2007. Extraction methods used were: locking stylets, telescoping sheaths ± laser, and femoral work stations.Results:One hundred and eighty‐three cases were referred, aged 65 ± 16 years (range 28–83); 76% were males. Mean implant time was 75 months (range 4–312 months) and indications were: pocket infection (48%), nonfunctioning lead (22%), erosion through skin (18%), endocarditis/septicemia (11%), bilateral superior vena cava thrombosis (0.5%), and painful lead (0.5%). The number of leads extracted were 369, with complete removal in 90.7% and partial in 7.6%. There were no intraoperative deaths but five (2.7%) died within the same admission as their extraction from overwhelming sepsis. Twelve deaths (6.6%) occurred during an average follow‐up of 965 days (range 40–1670).Multivariate logistic regression demonstrated that C‐reactive protein preprocedure was predictive of acute in‐hospital mortality.Conclusions:Intravascular lead extraction is a safe and efficient method of removing leads. However, there is a subgroup of patients with systemic sepsis with raised inflammatory markers who are at high risk of in‐hospital mortality. Long‐term follow‐up demonstrates mortality which is a marker of the underlying etiology for device implantation, with heart failure patients particularly at risk. (PACE 2010; 33:209–216)