Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

Paweł Stefańczyk, Dorota Nowosielecka (), Anna Polewczyk, Wojciech Jacheć, Andrzej Głowniak, Jarosław Kosior and Andrzej Kutarski
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Paweł Stefańczyk: Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Dorota Nowosielecka: Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
Anna Polewczyk: Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
Wojciech Jacheć: 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University in Katowice, 41-800 Zabrze, Poland
Andrzej Głowniak: Department of Cardiology, Medical University, 20-059 Lublin, Poland
Jarosław Kosior: Department of Cardiology, Masovian Specialist Hospital, 26-617 Radom, Poland
Andrzej Kutarski: Department of Cardiology, Medical University, 20-059 Lublin, Poland

IJERPH, 2022, vol. 20, issue 1, 1-16

Abstract: Background: Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. Methods: We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. Results: The need for an upgrade was the leading indication for TLE in only 36–66% of patients. In 42.0–57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1–76.4% of patients, functional leads were retained in 20.2–31.9%, non-functional leads were left in place in 0.0–1.1%, and non-functional superfluous leads were extracted in 3.6–8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Conclusions: Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.

Keywords: device upgrade; transvenous lead extraction; prophylaxis of lead abandonment; restoration of venous access (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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