Analysis of electrical lead failures in patients referred for transvenous lead extraction procedures

Abstract

We evaluated the influences of selected factors on electrical lead failure (ELF) occurrence in patients referred for transvenous lead extraction (TLE) procedures. The study cohort consisted of 432 patients referred for TLE procedures due to various indications (42 - lead-dependent infective endocarditis, 47 - pocket infection, 343 - noninfectious indications) with a total of 804 endocardial leads. In the analyzed group, there were 192 patients with ELF, denoted as group ELF(+) (200 malfunctioning endocardial leads). The percentage of women was higher in the ELF(+) group than in the ELF(-) group (42.7%vs 30.0%; P=0.006). The ELF(+) patients had more endocardial leads implanted via subclavian vein puncture (80.0%vs 72.4%; P=0.032), had more indwelling leads in the cardiovascular system (1.94vs 1.8; P=0.03), were older (68.9vs 66.0 years old; P=0.028), and had better left ventricular ejection fractions than the ELF(-) patients (48.0%vs 40.7%; P<0.001). The time interval to ELF occurrence was significantly longer for pacing leads than for cardioverter-defibrillator leads (95.7vs 65.7 months; P=0.016). The most important factor associated with ELF was subclavian vein puncture, increasing the risk of ELF occurrence by 2.5-fold and 2.7-fold in the univariate and multivariate Cox proportional hazards regression models, respectively. The presence of a cardioverter-defibrillator lead increased the risk of ELF by 1.9-fold and 2.7-fold in the univariate and multivariate models, respectively. The most significant factors predisposing patients to ELF are the lead implantation approach and the presence of a cardioverter-defibrillator lead.