Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

Justin Gould; Baldeep S. Sidhu; Bradley Porter; Benjamin J. Sieniewicz; Thomas Teall; Steven E. Williams; Anoop Shetty; Paolo Bosco; Christopher Blauth; Jaswinder Gill; Christopher A. Rinaldi

doi:10.1111/pace.13791

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

Justin Gould^*, Baldeep S. Sidhu, Bradley Porter, Benjamin J. Sieniewicz, Thomas Teall, Steven E. Williams, Anoop Shetty, Paolo Bosco, Christopher Blauth, Jaswinder Gill, Christopher A. Rinaldi

^*Corresponding author for this work

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Abstract

Background: Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods: All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results: Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P <.001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P <.001), 30-day procedure related major complications (including deaths) (8.5% vs 1.1%, P <.001) and emergency thoracotomy rates (4.2% vs 0.7%, P =.007). All-cause 30-day mortality rates were similar between groups (3.4% vs 2.0%, P =.315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion: Femoral approach TLE is associated with increased risk of 30-day procedure related major complications but not 30-day all-cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high-volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

Original language	English
Pages (from-to)	1355-1364
Number of pages	10
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	42
Issue number	10
Early online date	21 Aug 2019
DOIs	https://doi.org/10.1111/pace.13791
Publication status	Published - 1 Oct 2019

Keywords

bailout femoral extraction
femoral lead extraction
transvenous lead extraction

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10.1111/pace.13791

Prolonged lead dwell time_GOULD_Acc19Aug2019Epub21Aug2019_GREEN_AAMAccepted author manuscript, 613 KB

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title = "Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction",

abstract = "Background: Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods: All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results: Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P <.001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P <.001), 30-day procedure related major complications (including deaths) (8.5% vs 1.1%, P <.001) and emergency thoracotomy rates (4.2% vs 0.7%, P =.007). All-cause 30-day mortality rates were similar between groups (3.4% vs 2.0%, P =.315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion: Femoral approach TLE is associated with increased risk of 30-day procedure related major complications but not 30-day all-cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high-volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.",

keywords = "bailout femoral extraction, femoral lead extraction, transvenous lead extraction",

author = "Justin Gould and Sidhu, {Baldeep S.} and Bradley Porter and Sieniewicz, {Benjamin J.} and Thomas Teall and Williams, {Steven E.} and Anoop Shetty and Paolo Bosco and Christopher Blauth and Jaswinder Gill and Rinaldi, {Christopher A.}",

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doi = "10.1111/pace.13791",

language = "English",

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T1 - Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

AU - Gould, Justin

AU - Sidhu, Baldeep S.

AU - Porter, Bradley

AU - Sieniewicz, Benjamin J.

AU - Teall, Thomas

AU - Williams, Steven E.

AU - Shetty, Anoop

AU - Bosco, Paolo

AU - Blauth, Christopher

AU - Gill, Jaswinder

AU - Rinaldi, Christopher A.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods: All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results: Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P <.001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P <.001), 30-day procedure related major complications (including deaths) (8.5% vs 1.1%, P <.001) and emergency thoracotomy rates (4.2% vs 0.7%, P =.007). All-cause 30-day mortality rates were similar between groups (3.4% vs 2.0%, P =.315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion: Femoral approach TLE is associated with increased risk of 30-day procedure related major complications but not 30-day all-cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high-volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

AB - Background: Transvenous lead extraction (TLE) may be performed by superior approach using the original implant vein or via a femoral approach; however, limited comparative data exists. We compare outcomes between femoral versus nonfemoral TLE approaches and determine predictors of bailout transfemoral lead extraction in patients undergoing initial TLE via the original implant vein by a superior approach. Methods: All consecutive TLEs between October 2000 and March 2018 were prospectively collected (n = 1052). Patients were dichotomized into femoral (n = 118) and nonfemoral (n = 934) groups. Results: Demographics were balanced between femoral vs nonfemoral groups. Patients in the femoral group had significantly higher mean lead dwell times (11.6 ± 9.7 vs 6.6 ± 6.6 years, P <.001), mean number of leads extracted (2.7 ± 1.3 vs 2.0 ± 1.0, P <.001), 30-day procedure related major complications (including deaths) (8.5% vs 1.1%, P <.001) and emergency thoracotomy rates (4.2% vs 0.7%, P =.007). All-cause 30-day mortality rates were similar between groups (3.4% vs 2.0%, P =.315). Prolonged lead dwell time and increased number of leads extracted were predictive of a bailout transfemoral approach at multivariable analysis. Conclusion: Femoral approach TLE is associated with increased risk of 30-day procedure related major complications but not 30-day all-cause mortality. Prolonged lead dwell time and increased number of leads extracted are independent predictors for bailout transfemoral lead extraction. Such patients should be considered high risk of major complications and performed by high-volume lead extraction centers with experience in multiple approaches and techniques including experience with transfemoral lead extraction.

KW - bailout femoral extraction

KW - femoral lead extraction

KW - transvenous lead extraction

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U2 - 10.1111/pace.13791

DO - 10.1111/pace.13791

M3 - Article

C2 - 31433064

AN - SCOPUS:85071922815

SN - 0147-8389

VL - 42

SP - 1355

EP - 1364

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

IS - 10

ER -

Prolonged lead dwell time and lead burden predict bailout transfemoral lead extraction

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