Premium
Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads
Author(s) -
Claridge Simon,
Johnson Jonathan,
Sadnan Gazi,
Behar Jonathan M.,
Porter Bradley,
Sieniewicz Benjamin,
Jackson Tom,
Webb Jessica,
Gould Justin,
Sohal Manav,
Hamid Shoaib,
Patel Nik,
Gill Jaswinder,
Rinaldi Christopher A.
Publication year - 2018
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.13266
Subject(s) - medicine , odds ratio , confidence interval , implantable cardioverter defibrillator , multivariate analysis , extraction (chemistry) , complication , lead (geology) , chemistry , chromatography , geomorphology , geology
Background A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction. Methods A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead‐related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction. Results 807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02). Conclusions Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.