title: Trends, indications and outcomes of cardiac implantable device system extraction: a single UK centre experience over the last decade.
abstract: BACKGROUND
  The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade.
  
  
  METHODS
  Retrospective analysis of all consecutive patients undergoing lead extractions performed between 2001 and 2010. Procedural success and complications as defined by the Heart Rhythm Society policy.
  
  
  RESULTS
  A total of 745 leads were extracted with a procedural success of 98.9% [382 cases; partial success in 6.9% (26) cases] and failure in 1.1% (4). Major complication rate was 1% (four cases) and minor complication rate was 3.6%. By both univariate and multivariate analysis only duration of lead implantation was an indicator for success (p < 0.0001). The mean implantation time for failed lead extraction was 203 ± 64 months compared with 71.8 ± 16.5 months in the successful cohort (p < 0.0001). Laser-assisted extraction was required in 176 cases. With regard to extraction indication, lead malfunction/recall showed a significant increase during the study period (p = 0.03). On time trend analysis the rise in coronary sinus (CS) lead extraction over time was significant. (p = 0.02) Despite a trend for increased laser use over time this did not achieve statistical significance, p = 0.06.
  
  
  CONCLUSIONS
  A decade's experience of percutaneous lead extraction suggests that a high procedural success rate with a low complication rate is achieved in a high-volume centre. During this time, an increase in both defibrillator and CS lead explantation and a rising trend in laser assistance with almost 50% of cases needing laser usage were observed.
authors.affiliation: Guys & St Thomas' NHS Trust, Cardiothoracic Directorate, St Thomas' Hospital, London, UK. aruna.arujuna@kcl.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Arujuna
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.forename: J
authors.initials: J
authors.lastname: Whittaker
authors.forename: A
authors.initials: A
authors.lastname: Shetty
authors.forename: D
authors.initials: D
authors.lastname: Roy
authors.forename: J
authors.initials: J
authors.lastname: Bostock
authors.forename: S
authors.initials: S
authors.lastname: Kirubakaran
authors.forename: M
authors.initials: M
authors.lastname: O'Neill
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.forename: M
authors.initials: M
authors.lastname: Cooklin
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Blauth
authors.forename: C
authors.initials: C
authors.lastname: Bucknall
authors.forename: S
authors.initials: S
authors.lastname: Hamid
authors.forename: C A
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D020878:Device Removal / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D004696:Endocarditis / Q000209:etiology; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000639:trends; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult