Document Detail


Large, single-center, single-operator experience with transvenous lead extraction: outcomes and changing indications.
MedLine Citation:
PMID:  18325849     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lead extraction is increasingly necessary given the exponential growth in cardiac device implantation. Meanwhile, the tools, indications, and outcomes of this procedure continue to change. OBJECTIVE: The purpose of this study was to examine contemporary indications, outcomes, and complications of transvenous lead extraction in a large series of patients at a high-volume lead extraction center. METHODS: We performed a retrospective cohort study of consecutive patients undergoing lead extraction at a single, high-volume center. Patient and lead characteristics and the indications, outcomes, and need for laser assistance were analyzed. RESULTS: From January 2000 to March 2007, a total of 975 chronic endovascular leads were removed from 498 patients. Median implant duration was 5.7 years (range 0.5-32.7 years). Indications were infection (60.3%), mechanical lead failure (29.3%), and upgrade of device system (8.8%). Over the study period, lead malfunction decreased relative to other indications. Laser assistance for extraction was more likely with leads implanted longer than 3.4 years compared to less than 3.4 years (odds ratio 6.15, 95% confidence interval 3.35-11.28) and with implantable cardioverter-defibrillator leads compared to pacemaker leads (odds ratio 3.44, 95% confidence interval 1.84-6.43). Overall, 97.5% of the leads were completely removed. Major complications occurred in 2 (0.4%) patients. Only one patient required cardiac surgery. No deaths occurred. CONCLUSION: In a high-volume center, lead extraction has a high success rate and low complication rate. Infection was the most common indication overall. Lead failure has decreased in relative proportion. Implantable cardioverter-defibrillator leads and longer lead implant time are associated with a requirement for laser lead extraction.
Authors:
Samuel O Jones; Robert E Eckart; Christine M Albert; Laurence M Epstein
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-17
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-25     Completed Date:  2008-06-13     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  520-5     Citation Subset:  IM    
Affiliation:
Arrhythmia Service, Department of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA. samuel.jones@lackland.af.mil
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Bacterial Infections / etiology
Confidence Intervals
Defibrillators, Implantable / adverse effects*
Device Removal / adverse effects,  instrumentation*
Electrodes, Implanted / adverse effects*
Equipment Design
Equipment Failure
Female
Humans
Male
Middle Aged
Odds Ratio
Pacemaker, Artificial / adverse effects*
Retrospective Studies
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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