Abstract 16704: Impact of Infective versus Sterile Transvenous Lead Removal on Outcomes in Cardiac Implantable Electronic Devices

Abstract

Introduction: Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection. Methods: Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2017, and December 31, 2020. The indications of TLR were determined on the basis of the presence or absence of bacteremia, septicemia, sepsis, or endocarditis during the initial admission for CIED infection. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied. Results: Of the 25,144 patients who underwent TLR, 14,037 (55.8%) underwent TLR due to sterile indications and 11,114 (44.1%) underwent TLR due to infective indications with 4,495 patients with (40.5%) systemic and 6,612 (59.53%) with isolated pocket infection. Infective indications of TLR were associated with a significant increase in in-hospital mortality (8.73% vs 0.96%; OR= 5.89; 95% CI 4.81-7.20; <0.001) but not conversion to open heart surgery. Infective indications of TLR were also associated with a significantly increased risk of thromboembolic events of pulmonary emboli and embolic stroke (OR= 3.80; 95% CI 3.23-4.47, <0.001). Conclusions: A higher rate of thromboembolic events associated with infective indications of lead removal may warrant further pursuing this diagnosis in asymptomatic patients.