Outcomes and Complications of Lead Removal: Can We Establish a Risk Stratification Schema for a Collaborative and Effective Approach?

Hai Xia Fu, Xin Miao Huang, Li Zhong, Michael J. Osborn, Samuel J Asirvatham, Raul Emilio Espinosa, Peter A. Brady, Hon Chi Lee, Kevin L. Greason, Larry M. Baddour, Rizwan M. Sohail, Nancy G. Acker, David O. Hodge, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Background Removal of an entire cardio, vascular implantable electronic device is associated with morbidity and mortality. We sought to establish a risk classification scheme according to the outcomes of transvenous lead removal in a single center, with the goal of using that scheme to guide electrophysiology lab versus operating room extraction. Methods Consecutive patients undergoing transvenous lead removal from January 2001 to October 2012 at Mayo Clinic were retrospectively reviewed. Results A total of 1,378 leads were removed from 652 (age 64 ± 17 years, M 68%) patients undergoing 702 procedures. Mean (standard deviation) lead age was 57.6 (58.8) months. Forty-four percent of leads required laser-assisted extraction. Lead duration (P <0.001) and an implantable cardioverter defibrillator (ICD) lead (P <0.001) were associated with the need for laser extraction and procedure failure (P <0.0001 and P = 0.02). The major complication rate was 1.9% and was significantly associated with longer lead duration (odds ratio: 1.2, 95% confidence interval: 1.1-1.3; P <0.001). High-risk patients (with a >10-year-old pacing or a >5-year-old ICD lead) had significantly higher major events than moderate-risk (with pacing lead 1-10 years old or ICD lead 1-5 years old) and low-risk (any lead ≤1-year-old) patients (5.3%, 1.2%, and 0%, respectively; P <0.001). Conclusions Transvenous lead removal is highly successful, with few serious procedural complications. We propose a risk stratification scheme that may categorize patients as low, moderate, and high risk for lead extraction. Such a strategy may guide which extractions are best performed in the operating room.

Original languageEnglish (US)
Pages (from-to)1439-1447
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • cardio, vascular implantable electronic device
  • complication
  • lead removal
  • outcome
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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