TY - JOUR
T1 - Assessing long-term survival and hospitalization following transvenous lead extraction in patients with cardiac resynchronization therapy devices: A propensity score-matched analysis
AU - Mehta, Vishal S
AU - O'Brien, Hugh
AU - Elliott, Mark K
AU - Sidhu, Baldeep S
AU - Gould, Justin
AU - Shetty, Anoop K
AU - Niederer, Steven
AU - Rinaldi, Christopher A
PY - 2021/12/17
Y1 - 2021/12/17
N2 - Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices. A propensity score (PS)-matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed. Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (7 days) reimplantation was associated with poorer outcomes. Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00-93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74-1.39], = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87-1.66], = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04-2.57], = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00-2.46], = .049]. Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided. [Abstract copyright: © 2021 Heart Rhythm Society. Published by Elsevier Inc.]
AB - Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices. A propensity score (PS)-matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed. Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (7 days) reimplantation was associated with poorer outcomes. Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00-93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, no significant difference with respect to mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] [0.74-1.39], = .093) or hospitalization risk (HR = 1.2, 95% CI [0.87-1.66], = .265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR = 1.64, [1.04-2.57], = .032) and hospitalization risk (HR = 1.57, 95% CI [1.00-2.46], = .049]. Outcomes of CRT patients post TLE are similarly as poor as those of non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided. [Abstract copyright: © 2021 Heart Rhythm Society. Published by Elsevier Inc.]
KW - Mortality
KW - Propensity score matching
KW - Hospitalization
KW - Transvenous lead extraction
KW - CRT
KW - Cardiac resynchronization therapy
U2 - 10.1016/j.hroo.2021.10.006
DO - 10.1016/j.hroo.2021.10.006
M3 - Article
C2 - 34988504
SN - 2666-5018
VL - 2
SP - 597
EP - 606
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 6Part A
ER -