Abstract
Background: after transvenous lead extraction (TLE) of cardiac implantable electric devices (CIEDs), some patients may not benefit from device reimplantation. This study sought to analyse predictors and long-term outcome of patients after TLE with vs. without reimplantation in a high-volume centre. Methods: all patients undergoing TLE at our centre between January 2010 and November 2015 were included into this analysis. Results: a total of 223 patients (median age 70 years, 22.0% female) were included into the study. Cardiac resynchronization therapy-defibrillator (CRT-D) was the most common device (40.4%) followed by pacemaker (PM) (31.4%), implantable cardioverter-defibrillator (ICD) (26.9%), and cardiac resynchronization therapy-PM (CRT-P) (1.4%). TLE was performed due to infection (55.6%), malfunction (35.9%), system upgrade (6.7%) or other causes (1.8%). In 14.8%, no reimplantation was performed after TLE. At a median follow-up of 41 months, no preventable arrhythmia-related events were documented in the no-reimplantation group, but 11.8% received a new CIED after 17–84 months. While there was no difference in short-term survival, five-year survival was significantly lower in the no-reimplantation group (78.3% vs. 94.7%, p = 0.014). Conclusions: in patients undergoing TLE, a re-evaluation of the indication for reimplantation is safe and effective. Reimplantation was not related to preventable arrhythmia events, but all-cause survival was lower.
Highlights
Cardiovascular implantable electronic devices (CIED) are increasingly used for the treatment of brady- and tachy-arrhythmic cardiomyopathies, leading to rising numbers of patients with cardiac implantable electric devices (CIEDs) [1]
No repeat hospitalizations for invasive treatment of recurrent infection were documented (Supplemental Table S2). This analysis of consecutive patients undergoing transvenous lead extraction (TLE) at our centre reveals that (1) prevention of reimplantation was possible in a significant proportion of patients undergoing TLE with a low risk of arrhythmia-related events; (2) baseline comorbidities and the primary indication for CIED implantation are the main predictors for device reimplantation; and (3) long-term mortality was higher in patients without reimplantation, but mostly due to non-cardiac causes
This study shows that following a rigorous work-up, patients that do not profit from a CIED reimplantation can be identified with a low risk of complications due to undertreatment
Summary
Cardiovascular implantable electronic devices (CIED) are increasingly used for the treatment of brady- and tachy-arrhythmic cardiomyopathies, leading to rising numbers of patients with CIEDs [1]. The incidence of CIED-related complications is not negligible and in some situations transvenous lead extraction (TLE) is indicated. Other indications for TLE include lead failure associated with adverse arrhythmic effects, vein stenosis/occlusion, presence of recalled leads, or facilitation of MRI conditionality. TLE carries a non-negligible risk of procedure-related complications, such as cardiac tamponade, tricuspid valve regurgitation, embolization, vascular complications, and death [4]. Reimplantation of CIEDs after extraction puts the patient at risk of repeat infection or complications. For this reason, current guidelines recommend patients’ re-evaluation after explant, aiming to identify patients strictly requiring device reimplantation and those who can benefit from a conservative management [2,3]
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