Outcomes of Implantable Cardioverter Defibrillator (ICD)/Pacing Lead Extraction Over 8 Years
Alexandra Reph, Sophie Pickering, Samrah Ansari, Caitlin Hoeing, James Wu, MD.
Lehigh Valley Health Network, Allentown, PA, USA.
Use of Cardiac Implantable Electronic Devices (CIED) have progressively increased over the last decade, along with expanded indications for lead extractions. An understanding of complication risk factors is beneficial for optimal CIED management and lead extraction decision making. This is a retrospective analysis to evaluate procedural outcomes of 195 lead extraction patients at a community hospital from 2011-2018.
A Lead Extraction Database was created, and data was abstracted from EMR. Any correlation between risk factors and survivability was identified using a Kaplan-Meier Curve. Patients were grouped into risk factor subsets, and respective complication rates and survivability curves were compared to that of the overall population.
This population consisted of 37.4% patients > 75 Years, and 69.7% with >2 Comorbidities. The leading indication for lead extraction was Infection (40.0%). Successful Extraction occurred in 90.8% of the cases. The Complication Rate was 15.4% and the Perioperative Mortality Rate was 3.1%. Extraction Due to Infection and > 3 Leads Extracted risk factor subsets yielded 18.0% and 20.0% complication rates. These subset groups compared to general population Kaplan-Meier Curve (Figure 1) yielded p-values of 0.0028 and 0.0016.
Overall, this patient population is older and high risk. Despite this, complication rates remain low. Extraction Due to Infection and > 3 Leads Extracted patient cohorts have significantly lower survivability rates than those of the overall population.
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