title: Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience.
abstract: OBJECTIVE
  Owing to the increasing use of cardiac implantable electronic devices, there is a growing need for safe and effective techniques to manage device-related complications and lead dysfunction. Lead extraction remains a challenging procedure with inherent risks. We present the 30-day and long-term outcomes of lead extractions in the University Hospitals Leuven.
  
  
  RESULTS
  We report a retrospective cohort study of 176 patients admitted to the University Hospitals Leuven between January 2005 and December 2011, for the transvenous extraction of 295 leads. Indications for extraction were lead dysfunction and device upgrade in 84 (47.7%), pocket infection in 61 (34.7%), and systemic infection in 31 patients (17.6%). Extraction was successful in 95.5% of patients with complete removal of the leads or only a minor fragment remaining. One fatal peri-procedural complication occurred. Thirty-day mortality was 3.4% (n = 6). Systemic infection was the only significant predictor of 30-day mortality [odds ratio (OR) 29.706; P = 0.029]. A lower level of haemoglobin prior to extraction also tended to be related with a higher mortality, but this was not significant (OR 2.024; P = 0.082). One-year mortality was 8.5% (n = 15). Systemic infection (OR 9.727; P = 0.009), a lower level of haemoglobin (OR 1.597; P = 0.05), and a higher level of ureum (OR 1.021; P = 0.017) prior to extraction were significant predictors of 1-year mortality. Systemic infection was associated with significantly higher 30-day (19%), 1-year (32%), and long-term (39%) mortality rates.
  
  
  CONCLUSIONS
  Lead extraction can be safely and successfully performed in the majority of patients, with limited life-threatening complications. However, lead extraction because of systemic infection is associated with a significantly higher risk of short- and long-term mortality.
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Deckx
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marynissen
authors.affiliation: Department of Cardiac Surgery, University Hospitals Leuven, 3000 Leuven, Belgium Department of Cardiovascular sciences, University of Leuven, 3000 Leuven, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Rega
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular sciences, University of Leuven, 3000 Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Ector
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular sciences, University of Leuven, 3000 Leuven, Belgium.
authors.forename: Dieter
authors.initials: D
authors.lastname: Nuyens
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular sciences, University of Leuven, 3000 Leuven, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular sciences, University of Leuven, 3000 Leuven, Belgium Rik.Willems@uzleuven.be.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000401:mortality*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiovascular implantable electronic devices; Lead extraction; Mortality; Risk factors