Predictors of complications of endovascular chronic lead extractions from pacemakers and defibrillators: a single-operator experience.

ABSTRACT

BACKGROUND: National trends in chronic lead extractions from cardiac rhythm management (CRM) devices are on the rise. OBJECTIVE: The main objective of the study was to identify the predictors of complications of chronic lead extractions. METHODS: All patients who underwent endovascular chronic CRM lead extraction at our institution between 2002 and 2008 were included in this analysis. Demographic data as well as details of the extraction procedure and its complications within the ensuing 30 days were collected on all patients. RESULTS: Data of 212 consecutive patients (456 leads, age = 65 +/- 17 years, men 75%, left ventricular ejection fraction = 36 +/- 16%, coronary artery disease 80%, defibrillators 49%) were analyzed. There were a total of 26 (11.8%) complications in 25 patients including 9 (4.2%) major complications (death 1, hemothorax 4, pneumothorax 2, tamponade 1, stroke 1) and 17 (8.0%) minor complications. Independent predictors of any complications included a higher number of explanted right ventricular leads (HR = 3.51, P = 0.013). Explantation of ICD as opposed to a pacemaker device showed a strong trend toward significance (HR = 2.57, P = 0.053). An elevated white blood cell count also predicted major complications (HR = 1.52, P = 0.005). CONCLUSION: Predictors of complications after lead extraction procedures include a higher number of extracted leads and the presence of defibrillator as opposed to pacemaker leads. A new paradigm of the removal of all leads not connected to a device may, therefore, reduce the risk of complications from lead extraction procedures and deserves to be tested prospectively.