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.
Original language | English |
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Pages (from-to) | 209-16 |
Number of pages | 8 |
Journal | Pacing and clinical electrophysiology : PACE |
Volume | 33 |
Issue number | 2 |
DOIs | |
Publication status | Published - Feb 2010 |
Keywords
- Adult
- Aged
- Aged, 80 and over
- C-Reactive Protein/analysis
- Defibrillators, Implantable/microbiology
- Device Removal/methods
- Electrodes, Implanted
- Endocarditis/mortality
- Equipment Failure
- Female
- Heart Failure/mortality
- Hospital Mortality
- Humans
- Male
- Middle Aged
- Pacemaker, Artificial/microbiology
- Prognosis
- Risk Factors
- Sepsis/mortality