TY - JOUR
T1 - Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal
T2 - An ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry
AU - On behalf of the ELECTRa Investigators
AU - Nof, Eyal
AU - Bongiorni, Maria Grazia
AU - Auricchio, Angelo
AU - Butter, Christian
AU - Dagres, Nikolaos
AU - Deharo, Jean Claude
AU - Rinaldi, Christopher A.
AU - Maggioni, Aldo P.
AU - Kutarski, Andrzej
AU - Kennergren, Charles
AU - Laroche, Cécile
AU - Milman, Anat
AU - Beinart, Roy
AU - Bogdan, Stefan
AU - Mortsell, David
AU - Calvi, Valeria
AU - Desiron, Quentin
AU - Mansourati, Jacques
AU - Lundqvist, Carina Blomstrom
AU - Glikson, Michael
N1 - Publisher Copyright:
© 2019 Oxford University Press. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Aims: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved. Methods and results: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046]. Conclusion: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
AB - Aims: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved. Methods and results: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046]. Conclusion: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
KW - Cardiac implantable electronic devices
KW - Infection
KW - Lead extraction
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85077991860&partnerID=8YFLogxK
U2 - 10.1093/europace/euz269
DO - 10.1093/europace/euz269
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C2 - 31625553
AN - SCOPUS:85077991860
SN - 1099-5129
VL - 21
SP - 1876
EP - 1889
JO - Europace
JF - Europace
IS - 12
ER -