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Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The use of cardiac implantable electronic devices (CIEDs) has increased significantly over the last decades. With the development of transvenous lead extraction (TLE), procedural success rates also improved; however, data regarding long-term outcomes are still limited. The aim of our study was to analyze the outcomes after TLE, including reimplantation data, all-cause and cause-specific mortality.

Methods

Data from consecutive patients undergoing TLE in our institution between 2012 and 2020 were retrospectively analyzed. Periprocedural, 30-day, long-term, and cause-specific mortalities were calculated. We examined the original and the revised CIED indications and survival rate of patients with or without reimplantation.

Results

A total of 150 patients (age 66 ± 14 years) with 308 leads (dwelling time 7.8 ± 6.3 years) underwent TLE due to pocket infection (n = 105, 70%), endocarditis (n = 35, 23%), or non-infectious indications (n = 10, 7%). All-cause mortality data were available for all patients, detailed reimplantation data in 98 cases. Procedural death rate was 2% (n = 3), 30-day mortality rate 2.6% (n = 4). During the 3.5 ± 2.4 years of follow-up, 44 patients died. Arrhythmia, as the direct cause of death, was absent. Cardiovascular cause was responsible for mortality in 25%. There was no significant survival difference between groups with or without reimplantation (p = 0.136).

Conclusions

Despite the high number of pocket and systemic infection and long dwelling times in our cohort, the short- and long-term mortality after TLE proved to be favorable. Moreover, survival without a new device was not worse compared to patients who underwent a reimplantation procedure. Our study underlines the importance of individual reassessment of the original CIED indication, to avoid unnecessary reimplantation.

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Data availability

Clinical data were retrospectively collected from consecutive patients undergoing TLE between 2012 and 2020 at the University of Szeged.

Code availability

Not applicable

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Acknowledgements

The valuable contribution of G.K. in the study was performed in the University of Szeged, his current affiliation is Cardiology Department, Aalborg University Hospital, Aalborg, Denmark. The technical support of Eszter Toth from Premier G. Med is also greatly appreciated.

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Author notes

  1. Elod-Janos Zsigmond and Marton Miklos contributed equally to this work.

Authors and Affiliations

  1. Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis u. 8, Szeged, 6725, Hungary

    Elod-Janos Zsigmond, Marton Miklos, Adorjan Vida, Attila Benak, Attila Makai, Noemi Schvartz, Gergely Klausz, Laszlo Saghy & Mate Vamos

  2. Heart Surgery Department, University of Szeged, Szeged, Hungary

    Zoltan Hegedus & Gabor Bogats

Authors
  1. Elod-Janos Zsigmond
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Contributions

This study was designed and coordinated by A.M., G.K., A.B., L.S., and M.V. The database was designed mainly by G.K. and supplemented by M.V. Data acquisition was performed by E.J.ZS., M.M., A.V., A.B., N.S., G.K., Z.H., G.B., and M.V. Statistical analysis and interpretation of the results were carried out by E.J.ZS., M.M., A.V., A.B., L.S., and M.V. The manuscript was drafted by E.J.ZS., M.M., L.S., and M.V. and was critically revised by all the authors. E.J.ZS. and M.M. contributed equally to this work as first authors. All the authors read and confirmed the final manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mate Vamos.

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Ethics approval

The study was approved by the institutional review board of the University of Szeged and complies with the ethical guidelines of the Declaration of Helsinki.

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Not applicable.

Conflict of interest

M.V. reports consulting fees and/or nonfinancial support from Abott, Biotronik, Minimal Invasive Technology Ltd., and Sanofi-Aventis, outside the submitted work.

The other authors declare no conflict of interest.

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Zsigmond, EJ., Miklos, M., Vida, A. et al. Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort. J Interv Card Electrophysiol 66, 847–855 (2023). https://doi.org/10.1007/s10840-021-00974-4

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  • DOI: https://doi.org/10.1007/s10840-021-00974-4

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