Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads

Simon Claridge; Jonathan Johnson; Gazi Sadnan; Jonathan M. Behar; Bradley Porter; Benjamin Sieniewicz; Tom Jackson; Jessica Webb; Justin Gould; Manav Sohal; Shoaib Hamid; Nik Patel; Jaswinder Gill; Christopher A. Rinaldi

doi:10.1111/pace.13266

Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads

Simon Claridge^*, Jonathan Johnson, Gazi Sadnan, Jonathan M. Behar, Bradley Porter, Benjamin Sieniewicz, Tom Jackson, Jessica Webb, Justin Gould, Manav Sohal, Shoaib Hamid, Nik Patel, Jaswinder Gill, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction. Methods: A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead-related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction. Results: 807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02). Conclusions: Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.

Original language	English
Pages (from-to)	155-160
Number of pages	6
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	41
Issue number	2
DOIs	https://doi.org/10.1111/pace.13266
Publication status	Published - Feb 2018

Keywords

complications
device infection
lead malfunction
mortality
repeat procedure
transvenous lead extraction

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10.1111/pace.13266

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Claridge, S., Johnson, J., Sadnan, G., Behar, J. M., Porter, B., Sieniewicz, B., Jackson, T., Webb, J., Gould, J., Sohal, M., Hamid, S., Patel, N., Gill, J., & Rinaldi, C. A. (2018). Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads. PACE - Pacing and Clinical Electrophysiology, 41(2), 155-160. https://doi.org/10.1111/pace.13266

@article{5e09bc593bff4e0eba47d1d1fe365022,

title = "Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads",

abstract = "Background: A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction. Methods: A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead-related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction. Results: 807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02). Conclusions: Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.",

keywords = "complications, device infection, lead malfunction, mortality, repeat procedure, transvenous lead extraction",

author = "Simon Claridge and Jonathan Johnson and Gazi Sadnan and Behar, {Jonathan M.} and Bradley Porter and Benjamin Sieniewicz and Tom Jackson and Jessica Webb and Justin Gould and Manav Sohal and Shoaib Hamid and Nik Patel and Jaswinder Gill and Rinaldi, {Christopher A.}",

note = "Funding Information: SC, BP, MS, and JG receive funding as a fellows salary from St Jude Medical. TJ and BS have received funding as a fellows salary from Medtronic Inc. CAR has received funding from Spectranetics, SJM, Medtronic, Boston Scientific, and Livanova. Publisher Copyright: {\textcopyright} 2018 Wiley Periodicals, Inc.",

year = "2018",

month = feb,

doi = "10.1111/pace.13266",

language = "English",

volume = "41",

pages = "155--160",

journal = "PACE - Pacing and Clinical Electrophysiology",

issn = "0147-8389",

publisher = "Wiley",

number = "2",

}

Claridge, S, Johnson, J, Sadnan, G, Behar, JM , Porter, B , Sieniewicz, B , Jackson, T , Webb, J , Gould, J , Sohal, M, Hamid, S, Patel, N, Gill, J & Rinaldi, CA 2018, 'Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads', PACE - Pacing and Clinical Electrophysiology, vol. 41, no. 2, pp. 155-160. https://doi.org/10.1111/pace.13266

TY - JOUR

T1 - Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads

AU - Claridge, Simon

AU - Johnson, Jonathan

AU - Sadnan, Gazi

AU - Behar, Jonathan M.

AU - Porter, Bradley

AU - Sieniewicz, Benjamin

AU - Jackson, Tom

AU - Webb, Jessica

AU - Gould, Justin

AU - Sohal, Manav

AU - Hamid, Shoaib

AU - Patel, Nik

AU - Gill, Jaswinder

AU - Rinaldi, Christopher A.

N1 - Funding Information: SC, BP, MS, and JG receive funding as a fellows salary from St Jude Medical. TJ and BS have received funding as a fellows salary from Medtronic Inc. CAR has received funding from Spectranetics, SJM, Medtronic, Boston Scientific, and Livanova. Publisher Copyright: © 2018 Wiley Periodicals, Inc.

PY - 2018/2

Y1 - 2018/2

N2 - Background: A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction. Methods: A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead-related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction. Results: 807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02). Conclusions: Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.

AB - Background: A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction. Methods: A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead-related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction. Results: 807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P = 0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P = 0.02). Conclusions: Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.

KW - complications

KW - device infection

KW - lead malfunction

KW - mortality

KW - repeat procedure

KW - transvenous lead extraction

UR - http://www.scopus.com/inward/record.url?scp=85040963048&partnerID=8YFLogxK

U2 - 10.1111/pace.13266

DO - 10.1111/pace.13266

M3 - Article

C2 - 29314081

AN - SCOPUS:85040963048

SN - 0147-8389

VL - 41

SP - 155

EP - 160

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

IS - 2

ER -

Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads

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