| Title | Pacemaker and Defibrillator Lead Extraction: Predictors of Mortality during Follow-Up. | | Author(s) | Hamid S, Arujuna A, Ginks M, McPhail M, Patel N, Bucknall C, Rinaldi C | | Institution | Department of Cardiology, Queen Elizabeth Hospital, London, United Kingdom, and Guys and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom. | | Source | Pacing Clin Electrophysiol 2009 Nov 2. | | Abstract | Background:Extraction of cardiac implantable electric devices is an accepted procedure when systems become infected or malfunction. However, there is an associated morbidity and mortality. We report our 5-year experience and identify predictors of mortality, and long-term follow-up.
Methods:We analyzed extraction data from January 2003 to November 2007. Extraction methods used were: locking stylets, telescoping sheaths +/- laser, and femoral work stations.
Results:One hundred and eighty-three cases were referred, aged 65 +/- 16 years (range 28-83); 76% were males. Mean implant time was 75 months (range 4-312 months) and indications were: pocket infection (48%), nonfunctioning lead (22%), erosion through skin (18%), endocarditis/septicemia (11%), bilateral superior vena cava thrombosis (0.5%), and painful lead (0.5%). The number of leads extracted were 369, with complete removal in 90.7% and partial in 7.6%. There were no intraoperative deaths but five (2.7%) died within the same admission as their extraction from overwhelming sepsis. Twelve deaths (6.6%) occurred during an average follow-up of 965 days (range 40-1670). Multivariate logistic regression demonstrated that C-reactive protein preprocedure was predictive of acute in-hospital mortality.
Conclusions:Intravascular lead extraction is a safe and efficient method of removing leads. However, there is a subgroup of patients with systemic sepsis with raised inflammatory markers who are at high risk of in-hospital mortality. Long-term follow-up demonstrates mortality which is a marker of the underlying etiology for device implantation, with heart failure patients particularly at risk. (PACE 2009; 1-8). | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19889182 |
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