Mortality after transvenous lead extraction: A risk prediction model for sustainable care delivery

Abstract

Background and Aims:Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, the literature about the long-term impact of TLE on survivals is still lacking. Given these knowledge gaps, the aim of our study was to analyse very long-term mortality in patients undergoing TLE in public health perspective. Methods:This prospective, single-centre, observational study enrolled consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE, from January 2005 to January 2021. The main goal was to establish the independent predictors of very long-term mortality after TLE. We also aimed at assessing procedural and hospitalization-related costs. Results:We enrolled 435 patients (mean age 70 ± 12 years, with mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective indication to TLE (92%). Initial success of TLE was achieved in 98% of population. After a median follow-up of 4.5 years (range: 1 month-15.5 years), 150 of the 435 enrolled patients (34%) died. At multivariate analysis, death was predicted by: age (≥77 years, OR: 2.55, CI:1.8-3.6, p < 0.001), chronic kidney disease (CKD) defined as severe reduction of estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m 2 , OR: 1.75, CI:1.24-2.4, p = 0.001) and systolic dysfunction assessed before TLE defined as left ventricular ejection fraction (LVEF) <40%, OR: 1.78, CI 1.26-2.5, p = 0.001. Mean extraction cost was €5011 per patient without reimplantation and €6336 per patient with reimplantation respectively. Conclusions: Our study identified three predictors of long-term mortality in a high-risk cohort of patients with a cardiac device infection, undergoing successful How to cite this article: Narducci ML, Ruscio E, Nurchis MC, et al. Mortality after transvenous lead extraction: A risk prediction model for sustainable care delivery.

Unique Extraction of a Fractured Pacemaker Lead Adhered to the Spermatic Vein

“… 1 On the other hand, elderly patients have been reported to be 1 of the predictors of higher long-term mortality rates in patients undergoing TLE. 2 Additionally, the ELECTRa (The European Lead Extraction ConTRolled) registry has associated a previously abandoned lead at the time of TLE with increased procedural failure and major complications. 3 Hussein et al 4 have also reported that TLE in patients with abandoned leads was more likely to require specialized extraction tools and an adjunctive rescue femoral approach.…”