title: Long-term mortality after transvenous lead extraction.
abstract: BACKGROUND
  The number of cardiovascular implantable electronic devices has increased progressively and has led to an increased need for transvenous lead extraction (TLE). Multiple reports of TLE procedural outcomes exist; however, data regarding postprocedural and long-term mortality are limited.
  
  
  RESULTS
  We performed a retrospective study of consecutive patients undergoing TLE at a single, high-volume center. Patient characteristics, indications, and outcomes were analyzed. A multivariable Cox regression model was developed to identify factors associated with mortality. Between January 2000 and December 2010, 985 patients underwent 1043 TLE procedures. The cohort was 68% male, with a mean age of 63 years (range, 15-95 years) and a left ventricular ejection fraction of 40±17%. Indications included systemic infection (18%), pocket infection (32%), lead malfunction (30%), and other (device upgrade, venous occlusion, and advisory leads; 20%). There were no procedure-related deaths. The mean follow-up was 3.7 years (range, 0.1-11.3 years). Kaplan-Meier analysis demonstrated a cumulative mortality of 2.1% at 30 days, 4.2% at 3 months, 8.4% at 1 year, and 46.8% at 10 years. In multivariable analysis, systemic infection (hazard ratio [HR], 3.52; 95% CI, 1.95-6.38; P<0.0001), local infection (HR, 2.70; 95% CI, 1.55-4.67; P=0.0004), device system upgrade (HR, 2.14; 95% CI, 1.07-4.25; P=0.03; indication compared with a reference group of extraction for lead malfunction), diabetes mellitus (HR, 1.71; 95% CI, 1.25-2.35; P=0.0009), increasing age (HR, 1.05; 95% CI, 1.04-1.07; P<0.0001), and serum creatinine (HR, 1.16; 95% CI, 1.01-1.35; P=0.04) were significant correlates of increased mortality risk.
  
  
  CONCLUSIONS
  Although TLE procedural mortality is exceedingly low at high-volume centers, postprocedural and long-term mortality remain high in certain patient populations, such as elderly patients and those undergoing TLE for infectious indications and device system upgrade. Information regarding TLE long-term outcomes may help guide cardiovascular implantable electronic device and lead management.
authors.affiliation: Brigham and Women's Hospital, Boston, MA 02115, USA. mmaytin@partners.org
authors.forename: Melanie
authors.initials: M
authors.lastname: Maytin
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Jones
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D001424:Bacterial Infections; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods* / Q000401:mortality*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult