TY - JOUR
T1 - Outcomes of lead extraction without subsequent device reimplantation
AU - Al-Hijji, Mohammed A.
AU - Killu, Ammar M.
AU - Yousefian, Omid
AU - Hodge, David O.
AU - Park, Jae Yoon
AU - Hebsur, Shrinivas
AU - El Sabbagh, Abdallah
AU - Pretorius, Victor G.
AU - Ackerman, Michael J.
AU - Friedman, Paul A.
AU - Birgersdotter-Green, Ulrika
AU - Cha, Yong Mei
N1 - Publisher Copyright:
© 2017 The Author.
PY - 2017
Y1 - 2017
N2 - Aims Outcomes among patients who do not receive device reimplantation after cardiovascular implantable electronic device (CIED) extraction have not been well studied. The present study aims to investigate the outcomes of patients without device reimplantation after lead extraction and device removal. Methods and results We retrospectively searched for consecutive patients who underwent CIED extraction at Mayo Clinic, Rochester, MN and University of California San Diego Medical Center from 2001 through 2012. Among the patients identified, we compared characteristics of those who did and did not have device reimplantation. The Kaplan - Meier survival was analysed. Among 678 patients, 97 patients had their device extracted without reimplantation during 1-year follow-up ('noreimplant group'). Median age was younger in the no-reimplant group (60.7 vs. 70.6 years; P , 0.001). The reasons for no reimplantation were as follows: no longer meeting criteria for CIED (48%), inappropriate device indication at initial implantation (23%), patient preference (17%), and unresolved device complications (12%). Three major arrhythmias were reported in the no-reimplant group. Overall survival in the no-reimplant group was significantly lower than in the reimplant group (60 vs. 93%; P , 0.001). Ongoing device-related complications [hazard ratio (HR), 3.91; 95% CI, 1.74 - 8.81; P = 0.001], infection (HR, 3.06; 95% CI, 1.24 - 7.52; P = 0.02), and concurrent dialysis (HR, 2.74; 95% CI, 1.12 - 6.71; P = 0.03) were associated with increased mortality. Of 31 deaths in the no-reimplant group, 1 was secondary to cardiac arrhythmia. Conclusion Fourteen per cent of patients who had device extraction did not undergo reimplantation mainly because they no longer met CIED indications. The high mortality in these patients is related to device complications and comorbid conditions, whereas mortality associated with arrhythmia is rare.
AB - Aims Outcomes among patients who do not receive device reimplantation after cardiovascular implantable electronic device (CIED) extraction have not been well studied. The present study aims to investigate the outcomes of patients without device reimplantation after lead extraction and device removal. Methods and results We retrospectively searched for consecutive patients who underwent CIED extraction at Mayo Clinic, Rochester, MN and University of California San Diego Medical Center from 2001 through 2012. Among the patients identified, we compared characteristics of those who did and did not have device reimplantation. The Kaplan - Meier survival was analysed. Among 678 patients, 97 patients had their device extracted without reimplantation during 1-year follow-up ('noreimplant group'). Median age was younger in the no-reimplant group (60.7 vs. 70.6 years; P , 0.001). The reasons for no reimplantation were as follows: no longer meeting criteria for CIED (48%), inappropriate device indication at initial implantation (23%), patient preference (17%), and unresolved device complications (12%). Three major arrhythmias were reported in the no-reimplant group. Overall survival in the no-reimplant group was significantly lower than in the reimplant group (60 vs. 93%; P , 0.001). Ongoing device-related complications [hazard ratio (HR), 3.91; 95% CI, 1.74 - 8.81; P = 0.001], infection (HR, 3.06; 95% CI, 1.24 - 7.52; P = 0.02), and concurrent dialysis (HR, 2.74; 95% CI, 1.12 - 6.71; P = 0.03) were associated with increased mortality. Of 31 deaths in the no-reimplant group, 1 was secondary to cardiac arrhythmia. Conclusion Fourteen per cent of patients who had device extraction did not undergo reimplantation mainly because they no longer met CIED indications. The high mortality in these patients is related to device complications and comorbid conditions, whereas mortality associated with arrhythmia is rare.
KW - CIED
KW - Device extraction
KW - Mortality
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U2 - 10.1093/europace/euw184
DO - 10.1093/europace/euw184
M3 - Article
C2 - 27707785
AN - SCOPUS:85030532866
SN - 1099-5129
VL - 19
SP - 1527
EP - 1534
JO - Europace
JF - Europace
IS - 9
ER -