Outcomes of Transvenous Extraction of Leads Older Than 20 and 30 Years—A Large Cohort Study

Andrzej Kutarski, Andrzej Głowniak (), Jarosław Kosior, Wojciech Jacheć, Dorota Nowosielecka, Marek Czajkowski and Anna Polewczyk
Additional contact information
Andrzej Kutarski: Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
Andrzej Głowniak: Department of Cardiology, Medical University of Lublin, 20-954 Lublin, Poland
Jarosław Kosior: Department of Cardiology, Masovian Specialist Hospital in Radom, 20-617 Radom, Poland
Wojciech Jacheć: 2nd Department of Cardiology, Silesian Medical University, 41-808 Zabrze, Poland
Dorota Nowosielecka: Department of Cardiology, Pope John Paul II Hospital of Zamość, 22-400 Zamość, Poland
Marek Czajkowski: Department of Cardiac Surgery, Medical University of Lublin, 20-954 Lublin, Poland
Anna Polewczyk: Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, 25-317 Kielce, Poland

IJERPH, 2022, vol. 19, issue 21, 1-18

Abstract: Background: There is limited knowledge on outcome of transvenous lead extraction (TLE) of leads being 20 and 30 years old. Methods: Retrospective single center large database analysis containing 3673 TLE procedures performed from 2006 to 2020 was analysed. We aimed to compare procedure complexity and the incidence of the TLE major complications (MC) in groups where extracted leads were under 10 years, 10–20 years, 20–30 years (old) and over 30 years (very old). Results: Rate of removal of old and very old leads almost doubles with successive five-year periods (3–6-10%). In patients with old and very old leads there is an accumulation of risk factors for major complications of TLE (young age, female, multiple and/or abandoned leads, multiple previous procedures). The removal of old and very old leads was more labour-consuming, more difficult, and much more often required second-line (advanced) tools and complex techniques. Incidence of all MC grew parallel to age of removed leads from 0.6 to 18.2%; haemopericardium—from 0.3 to 12.1%, severe tricuspid valve damage—from 0.2 to 2.1%, need for rescue cardiac surgery—from 0.4 to 9.1%. Notably, there was no procedure-related death when old or very old lead was extracted. The percentages of clinical and procedural success decreased with increasing age of the removed leads from 99.2 and 97.8% to 90.9 and 81.8%. The risk of MC during extraction of leads aged 10–20 years increases 6.7 times, aged 20–30 years—14.3 times (amounting to 8.4%), and aged 30 and more years—20.4 times, amounting to 18.2%. Removal of ventricular leads is associated with a greater complexity of the procedure but not with more frequent MC. Removal of the atrial leads is associated with a higher incidence of MC, especially haemopericardium, regardless of the age of the leads, although the tendency becomes less pronounced with the oldest leads. Conclusions: 1. Extraction of old and very old leads is a rising challenge, since the rate of removal of leads aged 20-and-more years almost doubles with successive five-year periods. 2. Procedure difficulty, complexity and the risk of major complications increases along with the age of extracted lead. TLE is more time-consuming, difficult and much more often requires advanced tools and complex techniques. 3. TLE of old (≥20 years) or very old (≥30 years) leads can be performed with satisfactory success rate and safety profile when conducted at high-volume centre by an experienced operator under optimal safety conditions.

Keywords: transvenous lead extraction; old lead extraction; safety of lead extraction; effectiveness lead extraction; old leads (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/19/21/14184/pdf (application/pdf)
https://www.mdpi.com/1660-4601/19/21/14184/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:21:p:14184-:d:957936

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().