title: Predictors of Long-Term Survival Following Transvenous Extraction of Defibrillator Leads.
abstract: BACKGROUND
  Little data exist on long-term outcomes following extraction of implantable cardioverter defibrillator (ICD) leads, particularly for noninfectious indications. We sought to identify predictors of long-term survival after ICD lead extraction.
  
  
  METHODS
  We retrospectively reviewed ICD lead extractions at our institution (n = 508). Procedural outcomes and long-term survival were ascertained by medical records review.
  
  
  RESULTS
  Indication for lead extraction was infection in 32.5% and lead failure in 61.8%. Mean dwell time of the oldest extracted lead was 5.1 ± 5.9 years. Complete procedural success was achieved in 96.5% of cases. Major procedure-related complications occurred in 1.6% with six periprocedural deaths. During a mean follow-up of 866 ± 798 days, survival was significantly worse among patients with infection as the indication for extraction. At 1 year after extraction, survival among those with infection was 88.2%, compared to 95.0% in the lead failure cohort (P < 0.001). Procedural failure was a significant predictor of long-term mortality, even after excluding periprocedural deaths. In multivariate models, the presence of chronic kidney disease, increased number of leads requiring extraction, lower ejection fraction, and procedural failure were predictors of mortality.
  
  
  CONCLUSIONS
  Despite high rates of procedural success, infectious indication for ICD lead extraction is associated with increased long-term mortality. In contrast, among patients undergoing extraction for lead failure, long-term survival was excellent. The presence of procedural failure was a significant predictor of long-term mortality. Further studies will be necessary to better understand the mechanisms by which procedural failure may adversely impact long-term outcomes.
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Levy
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Heval M
authors.initials: HM
authors.lastname: Kelli
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hoskins
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lloyd
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: David B
authors.initials: DB
authors.lastname: Delurgio
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Langberg
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
mesh_terms: D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014680:Veins
keywords: cardiac implantable electronic device; implantable cardioverter defibrillator (ICD); infection; lead extraction