Transvenous lead extraction of implantable cardioverter‐defibrillators: A comprehensive outcome‐and risk factor analysis

Abstract

AbstractBackgroundDevice complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with transvenous implantable‐cardioverter‐defibrillator (ICD).ObjectivesAim of this study was to characterize the procedural outcome and risk‐factors of patients with indwelling 1‐ and 2‐chamber ICD undergoing TLE.MethodsWe conducted a subgroup analysis of all ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all‐cause mortality were assessed.ResultsWe identified 842 patients with an ICD undergoing TLE with the mean age of 62.8 ± 13.8 years. A total number of 1610 leads were treated with lead dysfunction (48.5%) as leading indication for extraction, followed by device‐related infection (45.4%). Lead‐per‐patient ratio was 1.91 ± 0.88 and 60.0% of patients had dual‐coil defibrillator leads. Additional extraction tools, such as mechanical rotating dilator sheaths and snares were utilized in 6.5% of cases. Overall procedural complications occurred in 4.3% with 2.0% major complications and a procedure‐related mortality of 0.8%. Clinical success rate was 97.9%. All‐cause in‐hospital mortality was 3.4%, with sepsis being the leading cause for mortality. Multivariate analysis revealed lead‐age ≥10 years (OR:5.82, 95%CI:2.1‐16.6; p = .001) as independent predictor for procedural failure. Systemic infection (OR:9.57, 95%CI:2.2‐42.4; p < .001) and procedural complications (OR:8.0, 95%CI:2.8‐23.3; p < .001) were identified as risk factors for all‐cause mortality.ConclusionsTLE is safe and efficacious in patients with 1‐ and 2‐chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device‐related infection is the main driver of all‐cause mortality for ICD patients undergoing TLE.