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

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. We...

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Published in:International journal of environmental research and public health 2022-12, Vol.20 (1), p.291
Main Authors: Stefańczyk, Paweł, Nowosielecka, Dorota, Polewczyk, Anna, Jacheć, Wojciech, Głowniak, Andrzej, Kosior, Jarosław, Kutarski, Andrzej
Format: Article
Language:English
Subjects:
Bioethics
Cardiac Resynchronization Therapy
Catheters
Complications
Defibrillators
Defibrillators, Implantable
Heart failure
Humans
Lead
Mortality
Pacemaker, Artificial
Pacemakers
Patients
Retrospective Studies
Success
Survival
Treatment Outcome
Veins & arteries
Venous access
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Summary: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. 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. 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%). 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.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph20010291