Assessing long term survival and hospitalisation following transvenous lead extraction in patients with cardiac resynchronisation therapy devices: A propensity score matched analysis

Background: Longer term outcomes of patients post transvenous lead extraction (TLE) is poorly understood in patients with cardiac resynchronisation therapy (CRT) devices. Objectives: A propensity score (PS) matched analysis evaluating outcomes post-TLE in CRT and non-CRT populations was performed. Methods: Data from consecutive patients undergoing TLE between 2000 to 2019 were prospectively collected. Patients surviving to discharge and re-implanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalisation was assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (<7 days) or late (>7 days) reimplantation was associated with poorer outcomes. Results: Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00-93.00] months, age at explant was 67.7±12.1 years, 83.3% were male and 54.4% had an infective indication for TLE. PS were calculated using 43 baseline characteristics. After matching, 192 CRT patients were compared with 192 non-CRT patients. In the matched cohort, there was no significant difference with respect to mortality (hazard ratio [HR]=1.01, 95% confidence interval [CI] [0.74-1.39], p=0.093) or hospitalisation risk (HR=1.2[0.87-1.66], p=0.265) was observed. In the matched CRT group, late reimplantation was associated with increased mortality (HR=1.64[1.04-2.57], p=0.032) and hospitalisation risk (HR=1.57[1.00-2.46], p=0.049]. Conclusion: Outcomes of CRT patients post-TLE is similarly poor to non-CRT patients in matched populations. Reimplantation within 7 days was associated with better outcomes in a CRT population but was not observed in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.