Abstract 9920: Outcomes Associated With Lead Abandonment versus Lead Extraction Strategies for Revision of Sterile Leads: An NCDR® Analysis
Introduction: While implantable cardioverter defibrillator (ICD) systems are lifesaving, leads often require replacement over time. When ICD leads require replacement, the existing lead can either be left in (abandoned) or be extracted, yet there are insufficient comparative data between these 2 strategies.
Methods: We examined in-hospital events among propensity matched subjects undergoing lead replacement where the existing lead was either abandoned or extracted from National Cardiovascular Data Registry (NCDR) ICD Registry (2010 - 2011). Six month complication and 90-day and 1-year mortality rates were examined in a subset of Medicare subjects. We excluded those procedures involving infection and those performed by a cardiothoracic surgeon (extraction predetermined).
Results: After 1:1 matching, we had 41744 subjects with in hospital outcomes, of which 2362 were Medicare aged and had 6-month complications and survival information. About 1/4 were women; average age was 66 yrs overall and 75 yrs in the Medicare cohort. In hospital events included 2.22% (n=463) and 3.63% (n=758) procedure related complications, and death in 0.21% (n=44) and 0.45% (n=94) in abandonment and extraction patients, respectively (p<0.001 for both). In the Medicare cohort, at 6 months, there was no difference with respect to bleeding (4.92% vs 5.40%), tamponade (0.38% vs 0.66%), infection (2.27 % vs 3.03%), upper extremity thrombosis (0.76% vs 0.95%), pulmonary embolism (0.28% vs 0.57%), or urgent surgery (1.70% vs 0.85%) (p>0.05 for all). At 90 days and 1 year, there was no difference in survival (p=0.55) (See Figure).
Conclusion: Among propensity-matched patients undergoing ICD lead replacement, there were more in-hospital complications and deaths among extraction versus abandonment subjects. Among a Medicare subset, there were no differences in longer term outcomes. Thus, abandonment may be a reasonable alternative to extraction for sterile lead revision in some cases.
Author Disclosures: E.P. Zeitler: None. Y. Wang: None. K. Dharmarajan: None. K.J. Anstrom: None. E.D. Peterson: None. J.P. Daubert: Research Grant; Significant; St Jude Medical, Medtronic Inc, Boston Scientific. Honoraria; Modest; Medtronic Inc, Boston Scientific, Biotronik. J.P. Curtis: None. S.M. Al-Khatib: None.
- © 2015 by American Heart Association, Inc.