Characterization of a previously unrecognized clinical phenomenon: Delayed shock after cardiac implantable electronic device extraction

Arwa Younis*, Roy Beinart, Nofrat Nehoray, Elad Asher, Shlomy Matetzky, Roy Beigel, Anat Wieder, Michael Glikson, Eyal Nof

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background Transvenous lead extraction remains a challenging procedure with inherent risk and associated complications. Objective We sought to characterize and evaluate predictors of delayed shock after transvenous lead extraction with no intraprocedural complications. Methods We retrospectively analyzed data of 217 consecutive patients who underwent extraction between 2010 and 2015. The primary end point was sudden onset of shock more than 4 hours after the completion of the procedure. Shock was defined as at least 30 minutes of persistent hypotension, necessitating vasopressors. Patients with mechanical or hemorrhagic shock were excluded. Results Seventeen patients (9%) developed delayed shock during the first 24 hours. Reasons for shock were sepsis (47%) or no apparent cause (53%). In multivariate analysis, patients with delayed shock had significantly lower glomerular filtration rate (median estimated glomerular filtration rate 53 mL/min vs 73 mL/min; P =.001), had more signs of systemic infection before extraction (fever, bacteremia, and leukocytosis; P <.05), and had more lead/tip remnants (29% vs 3%; P <.001). Patients presenting with delayed shock had significantly higher mortality rates at 1-year follow-up (10 [59%] vs 40 [23%], respectively; P <.01). Multivariate analysis adjusted for 1-year mortality risk was 114% higher (hazard ratio 2.14; 95% confidence interval 1.02–4.47; P <.05) in patients presenting with delayed shock. Conclusion We describe a previously unrecognized clinical phenomenon of delayed shock developing after extraction. Patients with predictors of this condition at baseline should be identified and followed up closely. Even with prompt treatment, long-term mortality rates remain high.

Original languageEnglish
Pages (from-to)1552-1558
Number of pages7
JournalHeart Rhythm
Volume14
Issue number10
DOIs
StatePublished - Oct 2017

Keywords

  • CIED infection
  • Mortality
  • Shock
  • Transvenous lead extraction

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