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Circulation: Arrhythmia and Electrophysiology
Although transvenous lead extraction is a fundamental part of cardiovascular device management, its safety and predictors of complications in the real-world setting have yet to be studied extensively. Using data from the National Cardiovascular Data Registry, the investigators found the rate of major complications and mortality to be similar to that reported in previous single-center studies, with rates of major complications of 2.3%. Given the high mortality with urgent cardiac surgery, the findings support planning for appropriate surgical backup before lead extractions.
Incidence and Predictors of Perioperative Complications With Transvenous Lead Extractions
Real-World Experience With National Cardiovascular Data Registry
Nitesh Sood, MD
David T. Martin, MD
Rachel Lampert, MD
Jeptha P. Curtis, MD
Craig Parzynski, MS
Jude Clancy, MD
Correspondence to: Nitesh Sood, MD, Cardiac Arrhythmia Services, Southcoast Health System, 363, Highland Avenue, Fall River, MA 02720. E-mail firstname.lastname@example.org
BACKGROUND: Transvenous lead extraction is an integral part of management of patients with cardiovascular implantable electronic devices. Real-world incidence and predictors of perioperative complications in extractions involving implantable cardioverter-defibrillator leads have not been described in detail.
METHODS AND RESULTS: Data from the National Cardiovascular Data Registry Implantable Cardioverter-Defibrillator Registry were analyzed. Lead extraction was defined as removal of leads implanted for >1 year. Predictors of major perioperative complications for all extraction procedures (11 304) and for high-voltage lead (8362, 74%), across 762 centers, were analyzed using univariate and multivariate logistic regression. Major complication occurred in 258 (2.3%) extraction procedures. Of these 258 with a complication, 41 (16%) required urgent cardiac surgery. Of these 41, 14 (34%) died during surgery. Among the total 98 (0.9%) deaths reported, 18 (0.16% of total) occurred during transvenous lead extraction. In multivariable logistic regression analysis, female sex, admission other than electively for procedure, ≥3 leads extracted, longer implant duration, dislodgement of other leads, and patient’s clinical status requiring lead extraction (infection/perforation) were associated with increased risk of complications. Smaller lead diameter, flat versus round …