Jamil Bashir1, Arthur J Lee2, Francois Philippon3, Blandine Mondesert4, Andrew D Krahn2, Mouhannad M Sadek5, Derek Exner6, Melissa Pak2, Jean Francois Legare7, Shahzad Karim2, Lynn Fedoruk2, Defen Peng2, Robert J Cusimano8, Ratika Parkash7, G Frank O Tyers2, Jason Andrade2. 1. Divisions of Cardiovascular Surgery and Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jbashir@providencehealth.bc.ca. 2. Divisions of Cardiovascular Surgery and Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. 3. Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada. 4. Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada. 5. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 6. Division of Cardiology, University of Calgary, Calgary, Alberta, Canada. 7. Divisions of Cardiac Surgery and Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada. 8. Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized. OBJECTIVE: The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population. METHODS: We performed a retrospective multicenter study examining patients undergoing lead extraction at 8 Canadian institutions from 1996 through 2016. Demographic and clinical data were used to identify variables associated with perforation and mortality using logistic regression modeling. RESULTS: A total of 2325 consecutive patients (age 61.9 ±16.5 years) underwent extraction of 4527 leads. Perforation rate was 2.7% (63/2325) and 30-day mortality was 1.6% (38/2325), with mortality of 0.4% due to perforation (10/2325). Variables associated with perforation included no previous cardiac surgery (odds ratio [OR] 3.33; 95% confidence interval [CI] 1.54-7.19; P = .002), female sex (OR 3.27; 95% CI 1.91-5.60; P <.001); left ventricular ejection fraction ≥40% (OR 2.81; 95% CI 1.28-6.14; P = .010); lead age >8 years (OR 2.64; 95% CI 1.52-4.60; P <.001); ≥2 leads extracted (OR 2.49; 95% CI 1.23-5.04; P = .011); and diabetes (OR 2.12; 95% CI 1.16-3.86; P = .014). Variables associated with death included infection as indication for extraction (OR 3.85; 95% CI 1.38-10.73; P = .010); anemia (OR 3.14; 95% CI 1.38-6.61; P = .003), and patient age (OR 1.04; 95% CI 1.01-1.07; P = .012). CONCLUSION: Risk factors associated with perforation in lead extraction include no history of cardiac surgery, female sex, preserved left ventricular ejection fraction, lead age >8 years, ≥2 leads extracted, and diabetes.
BACKGROUND: Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized. OBJECTIVE: The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population. METHODS: We performed a retrospective multicenter study examining patients undergoing lead extraction at 8 Canadian institutions from 1996 through 2016. Demographic and clinical data were used to identify variables associated with perforation and mortality using logistic regression modeling. RESULTS: A total of 2325 consecutive patients (age 61.9 ±16.5 years) underwent extraction of 4527 leads. Perforation rate was 2.7% (63/2325) and 30-day mortality was 1.6% (38/2325), with mortality of 0.4% due to perforation (10/2325). Variables associated with perforation included no previous cardiac surgery (odds ratio [OR] 3.33; 95% confidence interval [CI] 1.54-7.19; P = .002), female sex (OR 3.27; 95% CI 1.91-5.60; P <.001); left ventricular ejection fraction ≥40% (OR 2.81; 95% CI 1.28-6.14; P = .010); lead age >8 years (OR 2.64; 95% CI 1.52-4.60; P <.001); ≥2 leads extracted (OR 2.49; 95% CI 1.23-5.04; P = .011); and diabetes (OR 2.12; 95% CI 1.16-3.86; P = .014). Variables associated with death included infection as indication for extraction (OR 3.85; 95% CI 1.38-10.73; P = .010); anemia (OR 3.14; 95% CI 1.38-6.61; P = .003), and patient age (OR 1.04; 95% CI 1.01-1.07; P = .012). CONCLUSION: Risk factors associated with perforation in lead extraction include no history of cardiac surgery, female sex, preserved left ventricular ejection fraction, lead age >8 years, ≥2 leads extracted, and diabetes.
Authors: Jonathan P Piccini; Ryan Cunnane; Jan Steffel; Mikhael F El-Chami; Dwight Reynolds; Paul R Roberts; Kyoko Soejima; Clemens Steinwender; Christophe Garweg; Larry Chinitz; Christopher R Ellis; Kurt Stromberg; Dedra H Fagan; Lluis Mont Journal: Europace Date: 2022-07-21 Impact factor: 5.486
Authors: David Zweiker; Basma El Sawaf; Giuseppe D'Angelo; Andrea Radinovic; Alessandra Marzi; Luca R Limite; Antonio Frontera; Gabriele Paglino; Michael Spartalis; Donah Zachariah; Kenzaburo Nakajima; Paolo Della Bella; Patrizio Mazzone Journal: J Clin Med Date: 2022-08-19 Impact factor: 4.964