Procedural outcome and risk prediction in young patients undergoing transvenous lead extraction. A GALLERY subgroup analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The prevalence of young patients with cardiac implantable electronic devices (CIED) is continuously rising. Along with this development there is a concomitant increase in the incidence of CIED-related complications, such as device-related infections and lead failure. Transvenous lead extraction (TLE) has evolved into an indispensable therapeutic option for such cases. Aim The aim of this study was to analyze patient characteristics and procedural outcomes of young patients undergoing TLE and to identify independent risk factors for adverse events. Methods We performed a subgroup analysis of all patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) who were 45 years or younger at the time of enrollment. Predictor variables for all-cause mortality, procedural complications and procedural failure were assessed via multivariate analyses. Results We identified 160 patients (6.3% of the GALLERY) aged 45 years or younger with a mean age of 35.3±7.6 years and 42.5% (n=68) female patients. Mean body mass index was 25.6±5.4 kg/m2 and the proportion of patient with highly reduced ejection fraction (LVEF <30%) was 11.3%. Comorbidities, such as arterial hypertension (AHT), diabetes mellitus (DM) and chronic kidney disease (CKD) were present in 23.8%, 6.3% and 5.0% of patients, respectively. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2±1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Median procedural time was 88 [65-151.75] minutes. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. All-cause in-hospital mortality was 2.5%, which was mainly due to septic shock. Multivariate analysis revealed CKD as independent predictor for all-cause mortality (OR: 51.48; 95% CI: 1.98-1340.0; p=0.018). Lead age ≥10 years (OR: 14.58, 95% CI: 1.36-156.2; p=0.027) was identified as sole independent risk factor for procedural complication. Conclusion Transvenous lead extraction in young patients is safe and effective with a procedure-related mortality rate of 0.0%. All-cause mortality was mainly driven by patients succumbing to CIED-related sepsis, despite successful extraction. Chronic kidney disease and lead age ≥10 years are relevant risk factors in young patients undergoing TLE.