Wojciech Jacheć1, Andrzej Tomasik1, Anna Polewczyk2,3, Andrzej Kutarski4. 1. 2nd Department of Cardiology, Medical Faculty with Dentistry Division in Zabrze, Silesian Medical University, Katowice, Poland. 2. 2nd Clinical Cardiology Department, Świętokrzyskie Cardiology Center, Kielce, Poland. 3. Department of Health Sciences, The Jan Kochanowski University, Kielce, Poland. 4. Department of Cardiology, Medical University, Lublin, Poland.
Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) systems are considered as having higher risk of complication and shorter durability but reasons of this multifactorial phenomenon remain unclear. We aimed to analyze this problem in population of patients with ICD leads referred for lead extraction (TLE). METHODS: We have compared TLE indications, procedural results, and defined the long-term outcomes of TLE in patients with ICD/CRT-D devices (n = 482, ICD (+)) with lead extractions in patients with standard pacemakers (n = 1,402, ICD (-)). Demographic, clinical characteristics, and procedural outcomes were ascertained from single, primary operator registry. Long-term survival data were provided by the National Health Fund. RESULTS: The ICD (+) subgroup had a significantly higher incidence rate of either infective or noninfective indications for TLE. The clinical success rate of extraction was 99.2% in ICD (+) versus 97.4% in ICD (-) (P = 0.05) at a complication rate of 1.04% versus 2.14% (NS), respectively. In the median follow-up of 3.39 years, 142 patients from the ICD (+) subgroup and 303 from the ICD (-) subgroup died. The highest mortality rate of 41.1% was observed in the ICD (+) subgroup with infective indications. Infection, renal failure, diabetes, and age were the multivariate factors associated with increased mortality in the ICD (+) subgroup. CONCLUSION: ICD leads remain more vulnerable, with respect to mechanical failure and their propensity to infection, in comparison to pacing leads. Their TLE is very effective at least complication rate, when performed by a highly skilled and experienced operator. However, long-term mortality after their TLE is high and is affected mostly by infections or patient-related factors.
BACKGROUND: Implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) systems are considered as having higher risk of complication and shorter durability but reasons of this multifactorial phenomenon remain unclear. We aimed to analyze this problem in population of patients with ICD leads referred for lead extraction (TLE). METHODS: We have compared TLE indications, procedural results, and defined the long-term outcomes of TLE in patients with ICD/CRT-D devices (n = 482, ICD (+)) with lead extractions in patients with standard pacemakers (n = 1,402, ICD (-)). Demographic, clinical characteristics, and procedural outcomes were ascertained from single, primary operator registry. Long-term survival data were provided by the National Health Fund. RESULTS: The ICD (+) subgroup had a significantly higher incidence rate of either infective or noninfective indications for TLE. The clinical success rate of extraction was 99.2% in ICD (+) versus 97.4% in ICD (-) (P = 0.05) at a complication rate of 1.04% versus 2.14% (NS), respectively. In the median follow-up of 3.39 years, 142 patients from the ICD (+) subgroup and 303 from the ICD (-) subgroup died. The highest mortality rate of 41.1% was observed in the ICD (+) subgroup with infective indications. Infection, renal failure, diabetes, and age were the multivariate factors associated with increased mortality in the ICD (+) subgroup. CONCLUSION:ICD leads remain more vulnerable, with respect to mechanical failure and their propensity to infection, in comparison to pacing leads. Their TLE is very effective at least complication rate, when performed by a highly skilled and experienced operator. However, long-term mortality after their TLE is high and is affected mostly by infections or patient-related factors.
Authors: Paweł Stefańczyk; Dorota Nowosielecka; Anna Polewczyk; Łukasz Tułecki; Konrad Tomków; Wojciech Jacheć; Ewa Lewicka; Andrzej Tomaszewski; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2022-05-10 Impact factor: 4.614
Authors: Marcin Grabowski; Monika Gawałko; Marcin Michalak; Andrzej Cacko; Michał Kowara; Agnieszka Kołodzińska; Łukasz Januszkiewicz; Paweł Balsam; Laura Vitali Serdoz; Joachim Winter; Grzegorz Opolski Journal: Cardiol J Date: 2018-04-03 Impact factor: 2.737
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Łukasz Tułecki; Andrzej Kleinrok; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2021-02-14 Impact factor: 3.390