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Predictors of Long‐Term Survival Following Transvenous Extraction of Defibrillator Leads
Author(s) -
MERCHANT FAISAL M.,
LEVY MATHEW R.,
KELLI HEVAL M.,
HOSKINS MICHAEL H.,
LLOYD MICHAEL S.,
DELURGIO DAVID B.,
LANGBERG JONATHAN J.,
LEON ANGEL R.,
ELCHAMI MIKHAEL F.
Publication year - 2015
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/pace.12733
Subject(s) - medicine , term (time) , cardiology , intensive care medicine , quantum mechanics , physics
Background Little data exist on long‐term outcomes following extraction of implantable cardioverter defibrillator (ICD) leads, particularly for noninfectious indications. We sought to identify predictors of long‐term survival after ICD lead extraction. Methods We retrospectively reviewed ICD lead extractions at our institution (n = 508). Procedural outcomes and long‐term survival were ascertained by medical records review. Results Indication for lead extraction was infection in 32.5% and lead failure in 61.8%. Mean dwell time of the oldest extracted lead was 5.1 ± 5.9 years. Complete procedural success was achieved in 96.5% of cases. Major procedure‐related complications occurred in 1.6% with six periprocedural deaths. During a mean follow‐up of 866 ± 798 days, survival was significantly worse among patients with infection as the indication for extraction. At 1 year after extraction, survival among those with infection was 88.2%, compared to 95.0% in the lead failure cohort (P < 0.001). Procedural failure was a significant predictor of long‐term mortality, even after excluding periprocedural deaths. In multivariate models, the presence of chronic kidney disease, increased number of leads requiring extraction, lower ejection fraction, and procedural failure were predictors of mortality. Conclusion Despite high rates of procedural success, infectious indication for ICD lead extraction is associated with increased long‐term mortality. In contrast, among patients undergoing extraction for lead failure, long‐term survival was excellent. The presence of procedural failure was a significant predictor of long‐term mortality. Further studies will be necessary to better understand the mechanisms by which procedural failure may adversely impact long‐term outcomes.