Long-Term Outcomes Following Transvenous Lead Extraction

Abstract

Long-term mortality following TLE is high, particularly in those with systemic infection, procedural complications, advanced age, and renal impairment. Retained fragments are a risk factor for CDI post extraction.

Efficacy and safety of the subcutaneous implantable cardioverter defibrillator: a systematic review

“…However, implant-related complications associated with transvenous lead placement, including pneumothorax, cardiac perforation and tamponade, occur in 3%,1 while long-term complications such as infection, endocarditis and lead failure occur in up to 20% of TV-ICD leads at 10 years 2. Extraction of transvenous leads carries significant morbidity and mortality 3. The subcutaneous implantable cardioverter defibrillator (S-ICD) system is entirely extravascular, offering the potential to address these shortcomings 4…”

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

“…31 System extraction is associated with a small risk of major complications, particularly vascular lacerations causing haemothorax and death. 32,70,[79][80][81][82] Extraction-related mortality rates are 0.1-0.8 % in large experienced centres. 70,83 In one large, single-centre study, including more than 5,000 lead extractions, 43 % of which were due to infection, risk of major complications was 1.8 %, and minor complications 3.6 %.…”

“…10,68,69 In a recent study, it was found that the rate of CIED infection after CIED extraction was higher in patients with incomplete lead removal, 13.5 % versus 3.0 %. 70 In addition, mortality appears higher without complete removal. [71][72][73] One study indicated a threefold higher mortality without system removal.…”

“…74 All-cause mortality following CIED infection is considerable, ranging from 6 % to 35 % at 2 years or longer follow-up, although many deaths are not infection-related. 10,66,70,[74][75][76] In most of these studies, more than 90 % of patients underwent complete CIED removal. Mortality with endocarditis is reported between 24.5 % and 29.0 %, 31,71,77 and CIED infections with endocarditis have a higher mortality than pocket infection.…”

Lead Extraction: The Importance of Preparation and Remaining Opportunities

“…[4][5][6][7] Anticipating complications before they happen is the watchword in lead extractions. [4][5][6][7] Anticipating complications before they happen is the watchword in lead extractions.…”