Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads

Frank Bracke (Corresponding author), Niels Verberkmoes, Marcel van 't Veer, Berry van Gelder

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Aims: Abandoned leads are often linked to complications during lead extraction, prompting pre-emptive extraction if leads become non-functional. We examined their influence on complications when extracted for device-related infection. Methods and results: All patients undergoing lead extraction for device-related infection from 2006 to 2017 in our hospital were included. The primary endpoint was major complications. Out of 500 patients, 141 had abandoned leads, of whom 75% had only one abandoned lead. Median cumulative implant times were 24.2 (interquartile range 15.6-38.2) and 11.6 (5.6-17.4), respectively years with or without abandoned leads. All leads were extracted only with a femoral approach in 50.4% of patients. Mechanical rotational tools were introduced in 2014 and used in 22.2% of cases and replacing laser sheaths that were used in 5% of patients. Major complications occurred in 0.7% of patients with abandoned leads compared with 1.7% of patients with only active leads (P = 0.679). Failure to completely remove all leads was 14.9% and 6.4%, respectively with or without abandoned leads (P = 0.003), and clinical failure was 6.4% and 2.2% (P = 0.028), respectively. Procedural failure dropped to 9.2% and 5.7% (P = 0.37), respectively after the introduction of mechanical rotational tools. The only independent predictor of procedural and clinical failure in multivariate analysis was the cumulative implant duration. Conclusion: Despite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted.

Original languageEnglish
Pages (from-to)1378-1384
Number of pages7
JournalEuropace
Volume21
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • Abandoned leads
  • Cardiac implantable electronic device infection
  • Complications
  • Lead extraction

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