Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal: an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry.
Nof, Eyal; Bongiorni, Maria Grazia; Auricchio, Angeloet al.
2019 • In Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 21 (12), p. 1876 - 1889
[en] [en] AIMS: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved.
METHODS AND RESULTS: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046].
CONCLUSION: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Nof, Eyal; Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Butter, Christian; Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Bernau, Germany
Dagres, Nikolaos ; Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Deharo, Jean-Claude; CHU La Timone, Cardiologie, Service du prof Deharo, Marseille, France
Rinaldi, Christopher A; Cardiology Department, Guy's and St Thomas' Hospitals, London, UK
Maggioni, Aldo P ; ANMCO Research Center, Florence, Italy ; EURObservational Research Programme, European Society of Cardiology, Biot, Sophia-Antipolis, France
Kutarski, Andrzej ; Department of Cardiology, Medical University of Lublin, Lublin, Poland
Kennergren, Charles; Sahlgrenska University Hospital, Cardiothoracic Surgery, Sahlgrenska/SU, Goteborg, Sweden
Laroche, Cécile; EURObservational Research Programme, European Society of Cardiology, Biot, Sophia-Antipolis, France
Milman, Anat ; Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Beinart, Roy; Davidai Arrhythmia Center, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer 5265601, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Bogdan, Stefan; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
Mortsell, David; Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
Calvi, Valeria; Policlinico G. Rodolico, AZ.OU Policlinico-V. Emanuele, Catania, Italy
DESIRON, Quentin ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
Mansourati, Jacques; Department of Cardiology, University Hopsital of Brest, Brest, France
Blomstrom Lundqvist, Carina; Department of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
Glikson, Michael; Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal: an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry.
Publication date :
01 December 2019
Journal title :
Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
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