Safety and Effectiveness of Transvenous Lead Extraction in Patients with Infected Cardiac Resynchronization Therapy Devices; Is It More Risky than Extraction of Other Systems?

Paweł Stefańczyk, Dorota Nowosielecka, Anna Polewczyk, Łukasz Tułecki, Konrad Tomków, Wojciech Jacheć, Ewa Lewicka, Andrzej Tomaszewski and Andrzej Kutarski
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Paweł Stefańczyk: Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland, 22-400 Zamość, Poland
Dorota Nowosielecka: Department of Cardiology, The Pope John Paul II Province Hospital of Zamość Poland, 22-400 Zamość, Poland
Anna Polewczyk: Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-369 Kielce, Poland
Łukasz Tułecki: Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland, 22-400 Zamość, Poland
Konrad Tomków: Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość Poland, 22-400 Zamość, Poland
Wojciech Jacheć: Department of Cardiology, Faculty of Medical Science in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland
Ewa Lewicka: Department of Cardiology and Electrocardiotherapy, Medical University of Gdańsk, 80-416 Gdańsk, Poland
Andrzej Tomaszewski: Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
Andrzej Kutarski: Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland

IJERPH, 2022, vol. 19, issue 10, 1-13

Abstract: Background: Transvenous lead extraction (TLE) in patients with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices is considered as more risky. The aim of this study was to assess the safety and effectiveness of TLE in patients with infected CRT systems. Methods: Data of 3468 patients undergoing TLE in a single high-volume center in years 2006–2021 were analyzed. The clinical and procedural parameters as well as the efficacy and safety of TLE were compared between patients with infected CRT and pacemakers (PM) and ICD systems. Results: Infectious indications for TLE occurred in 1138 patients, including 150 infected CRT (112 CRT-D and 38 CRT-P). The general health condition of CRT patients was worse with higher Charlson’s comorbidity index. The number of extracted leads was higher in the CRT group, but implant duration was significantly longer in the PM than in the ICD and CRT groups (98.93 vs. 55.26 vs. 55.43 months p < 0.01). The procedure was longer in duration, more difficult, and more complex in patients with pacemakers than in those in the CRT group. The occurrence of major complications and clinical and procedural success as well as procedure-related death did not show any relationship to the type of CIED device. Mortality at more than one-year follow-up after TLE was significantly higher among patients with CRT devices (22.7% vs. 8.7%) than among those in the PM group. Conclusion: Despite the greater burden of lead and comorbidities, the complexity and efficiency of removing infected CRT systems is no more dangerous than removing other infected systems. The duration of the implant seems to play a dominant role.

Keywords: transvenous lead extraction; cardiac resynchronization therapy; infectious indications; safety and effectiveness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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