TY - JOUR
T1 - Trends in use and adverse outcomes associated with transvenous lead removal in the United States
AU - Deshmukh, Abhishek
AU - Patel, Nileshkumar
AU - Noseworthy, Peter A.
AU - Patel, Achint A.
AU - Patel, Nilay
AU - Arora, Shilpkumar
AU - Kapa, Suraj
AU - Noheria, Amit
AU - Mulpuru, Siva
AU - Badheka, Apurva
AU - Fischer, Avi
AU - Coffey, James O.
AU - Cha, Yong Mei
AU - Friedman, Paul
AU - Asirvatham, Samuel
AU - Viles-Gonzalez, Juan F.
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015
Y1 - 2015
N2 - Background - Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications. Methods and Results - Using the Nationwide Inpatient Sample, we identified 91 890 TLR procedures. We investigated common complications including pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with TLR, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. We specifically assessed in-hospital death (2.2%), hemorrhage requiring transfusion (2.6%), vascular complications (2.0%), pericardial complications (1.4%), open heart surgery (0.2%), and postoperative respiratory failure (2.4%). Independent predictors of complications were female sex and device infections. Hospital volume was not independently associated with higher complications. There was a significant rise in overall complication rates over the study period. Conclusions - The overall complication rate in patients undergoing TLR was higher than previously reported. Female sex and device infections are associated with higher complications. Hospital volume was not associated with higher complication rates. The number of adverse events in the literature likely underestimates the actual number of complications associated with TLR.
AB - Background - Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications. Methods and Results - Using the Nationwide Inpatient Sample, we identified 91 890 TLR procedures. We investigated common complications including pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with TLR, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. We specifically assessed in-hospital death (2.2%), hemorrhage requiring transfusion (2.6%), vascular complications (2.0%), pericardial complications (1.4%), open heart surgery (0.2%), and postoperative respiratory failure (2.4%). Independent predictors of complications were female sex and device infections. Hospital volume was not independently associated with higher complications. There was a significant rise in overall complication rates over the study period. Conclusions - The overall complication rate in patients undergoing TLR was higher than previously reported. Female sex and device infections are associated with higher complications. Hospital volume was not associated with higher complication rates. The number of adverse events in the literature likely underestimates the actual number of complications associated with TLR.
KW - Complications
KW - Device infection
KW - Lead removal
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U2 - 10.1161/CIRCULATIONAHA.114.013801
DO - 10.1161/CIRCULATIONAHA.114.013801
M3 - Article
C2 - 26534954
AN - SCOPUS:84953305294
SN - 0009-7322
VL - 132
SP - 2363
EP - 2371
JO - Circulation
JF - Circulation
IS - 25
ER -