Outcomes and Complications of Lead Removal: Can We Establish a Risk Stratification Schema for a Collaborative and Effective Approach?. Issue 12 (22nd September 2015)

• Record Type: Journal Article
• Authors: FU, HAI‐XIA; HUANG, XIN‐MIAO; ZHONG, LI; OSBORN, MICHAEL J.; ASIRVATHAM, SAMUEL J.; ESPINOSA, RAUL E.; BRADY, PETER A.; LEE, HON‐CHI; GREASON, KEVIN L.; BADDOUR, LARRY M.; SOHAIL, RIZWAN M.; ACKER, NANCY G.; HODGE, DAVID O.; FRIEDMAN, PAUL A.; CHA, YONG‐MEI
• Is Part Of: Pacing and clinical electrophysiology. Volume 38:Issue 12(2015:Dec.)
• Page Start: 1439
• Page End: 1447
• Publication Date: 2015-09-22
• Subjects: cardiovascular implantable electronic device -- complication -- lead removal -- outcome -- survival; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.12736
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract : Background: Removal of an entire cardiovascular implantable electronic device is associated with morbidity and mortality. We sought to establish a risk classification scheme according to the outcomes of transvenous lead removal in a single center, with the goal of using that scheme to guide electrophysiology lab versus operating room extraction. Methods: Consecutive patients undergoing transvenous lead removal from January 2001 to October 2012 at Mayo Clinic were retrospectively reviewed. Results: A total of 1, 378 leads were removed from 652 (age 64 ± 17 years, M 68%) patients undergoing 702 procedures. Mean (standard deviation) lead age was 57.6 (58.8) months. Forty‐four percent of leads required laser‐assisted extraction. Lead duration (P < 0.001) and an implantable cardioverter defibrillator (ICD) lead (P < 0.001) were associated with the need for laser extraction and procedure failure (P < 0.0001 and P = 0.02). The major complication rate was 1.9% and was significantly associated with longer lead duration (odds ratio: 1.2, 95% confidence interval: 1.1–1.3; P < 0.001). High‐risk patients (with a >10‐year‐old pacing or a >5‐year‐old ICD lead) had significantly higher major events than moderate‐risk (with pacing lead 1–10 years old or ICD lead 1–5 years old) and low‐risk (any lead ≤1‐year‐old) patients (5.3%, 1.2%, and 0%, respectively; P < 0.001). Conclusions: Transvenous lead removal is highly successful, with few serious procedural complications. We propose a risk stratification scheme that may categorize patients as low, moderate, and high risk for lead extraction. Such a strategy may guide which extractions are best performed in the operating room.