TY - JOUR
T1 - Causes of Early Mortality After Transvenous Lead Removal
AU - Lee, Justin Z.
AU - Tan, Min Choon
AU - Karikalan, Suganya
AU - Deshmukh, Abhishek J.
AU - Sorajja, Dan
AU - Valverde, Arturo
AU - Srivathsan, Komandoor
AU - Scott, Luis
AU - Kusumoto, Fred M.
AU - Friedman, Paul A.
AU - Asirvatham, Samuel J.
AU - Mulpuru, Siva K.
AU - Cha, Yong Mei
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/12
Y1 - 2022/12
N2 - Background: Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. Objectives: This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. Methods: A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. Results: A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. Conclusions: The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.
AB - Background: Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. Objectives: This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. Methods: A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. Results: A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. Conclusions: The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.
KW - complications
KW - lead extraction
KW - mortality
KW - outcome assessment
KW - transvenous lead removal
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U2 - 10.1016/j.jacep.2022.08.006
DO - 10.1016/j.jacep.2022.08.006
M3 - Article
C2 - 36543507
AN - SCOPUS:85143858070
SN - 2405-500X
VL - 8
SP - 1566
EP - 1575
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 12
ER -