Risk factors for severe complications of transvenous lead extraction

Abstract

Objective To find out the risk factors of major complications with transvenous lead extraction involving cardiovascular implantable electronic devices. Methods All patients who underwent transvenous lead extraction in heart center of People’s Hospital between Jan 1st 2012 and Dec 31st 2017 were included in this study. The patients were divided into complication group and control group. All medical records were reviewed and data pertaining to patient demographics, type of devices, dates from original device implantation, number of all total leads extracted, number of right atrial leads extracted, number of right ventricular leads extracted, number of implantable cardioverter defibrillator (ICD) leads extracted, left ventricular leads extracted, and extraction methods were recorded. Univariate and multivariate logistic regression analysis were used to identify, the risk factors for severe complications during transvenous extraction procedures. Results A total of 1 832 leads were removed from 922 patients during studying period. Among them, 751 right atrial leads, 917 right ventricular leads, 74 left ventricular leads, and 90 ICD leads were removed. Sixteen severe complications occurred, including 12 tamponade, 3 acute tricuspid valve regurgitation requiring emergency open-heart surgery, and 1 pulmonary embolism needing embolectomy. Both univariate and multivariable logistic regression analysis showed that the number of right atrial leads removed and the duration of initial device implantation were risk factors for serious complications (OR=3.056, 95%CI 1.174-7.958, P=0.022; OR=1.102, 95%CI 1.029-1.180, P=0.005, respectively) . Conclusions Tamponade is the commonest major complication with lead extraction procedures. Number of right atrial leads and time after leads implantation are risk factors for severe perioperative complication of lead extraction. Key words: Pacemaker, artificial; Electrodes, implanted; Intraoperative complications; Risk factors