Abstract 14528: Outcomes from a Large, Single-Center Experience of Over Five Thousand Chronic Endovascular Pacemaker and Defibrillator Lead Extractions

Abstract

Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. Objectives: This study sought to examine the safety and efficacy of endovascular pacemaker and defibrillator lead extraction and the indications, outcomes, and risk factors.

Methods: Consecutive patients undergoing endovascular lead extraction at the Cleveland Clinic were included in the analysis.

Results: Between August 1996 and August 2011, 3,013 consecutive patients (age 64 + 16 years) underwent extraction of 5,549 endovascular leads. Defibrillator leads were extracted in 40.6% of the procedures. Median implant duration was 57.4 months (0.07 to 413.1 months). The most common indications for lead extraction included infection (43.1%), malfunction (36.1%), and device upgrade (16.5%). Laser extraction tools were used in 69.8% of the procedures. Leads were completely removed in 95.6% of the procedures, with 97.2% clinical success. Procedural failure was more common in leads implanted for > 5 years. Major adverse events (MAE) in 69 patients (2.3%) were directly related to the procedure including 11 deaths (0.4%). The most common MAE were bleeding requiring transfusion (0.9%), vascular laceration (0.5%), cardiac avulsion (0.4%), and respiratory arrest (0.3%). MAE and failure to achieve clinical success were both associated with platelet count < 150 k/uL, creatinine > 2 mg/dl, leads implanted for > 5 years, and laser extraction. Overall all-cause in-hospital mortality at 30 days was 1.5%. In patients with endocarditis or pocket infection, all-cause in-hospital mortality at 30 days was 2.6%. All-cause in-hospital mortality at 30 days was associated with age > 65 years, diabetes, end stage renal disease, BMI < 25 kg/m², and NYHA functional class 3 or 4.

Conclusions: The data represent the largest contemporary series of endovascular lead extractions reported in the literature. Lead extraction in this single-center experience was highly successful and associated with a low procedural complication rate.