Pacemaker and defibrillator lead extraction: predictors of mortality during follow-up.
BACKGROUND
Extraction of cardiac implantable electric devices is an accepted procedure when systems become infected or malfunction. However, there is an associated morbidity and mortality. We report our 5-year experience and identify predictors of mortality, and long-term follow-up.


METHODS
We analyzed extraction data from January 2003 to November 2007. Extraction methods used were: locking stylets, telescoping sheaths +/- laser, and femoral work stations.


RESULTS
One hundred and eighty-three cases were referred, aged 65 +/- 16 years (range 28-83); 76% were males. Mean implant time was 75 months (range 4-312 months) and indications were: pocket infection (48%), nonfunctioning lead (22%), erosion through skin (18%), endocarditis/septicemia (11%), bilateral superior vena cava thrombosis (0.5%), and painful lead (0.5%). The number of leads extracted were 369, with complete removal in 90.7% and partial in 7.6%. There were no intraoperative deaths but five (2.7%) died within the same admission as their extraction from overwhelming sepsis. Twelve deaths (6.6%) occurred during an average follow-up of 965 days (range 40-1670). Multivariate logistic regression demonstrated that C-reactive protein preprocedure was predictive of acute in-hospital mortality.


CONCLUSIONS
Intravascular lead extraction is a safe and efficient method of removing leads. However, there is a subgroup of patients with systemic sepsis with raised inflammatory markers who are at high risk of in-hospital mortality. Long-term follow-up demonstrates mortality which is a marker of the underlying etiology for device implantation, with heart failure patients particularly at risk.
Hamid
Shoaib
S
Department of Cardiology, Queen Elizabeth Hospital, and Guys and St.Thomas' Hospital NHS Foundation Trust, London, United Kingdom. shoaibhamid@nhs.net
Arujuna
Aruna
A
Ginks
Matthew
M
McPhail
Mark
M
Patel
Nikhil
N
Bucknall
Cliff
C
Rinaldi
Christopher
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D017147:Defibrillators, Implantable / Q000382:microbiology*; D020878:Device Removal / Q000379:methods* / Q000401:mortality*; D004567:Electrodes, Implanted; D004696:Endocarditis / Q000401:mortality; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D011379:Prognosis; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality
D002097:C-Reactive Protein