title: Outcomes and Complications of Lead Removal: Can We Establish a Risk Stratification Schema for a Collaborative and Effective Approach?
abstract: BACKGROUND
  Removal of an entire cardiovascular implantable electronic device is associated with morbidity and mortality. We sought to establish a risk classification scheme according to the outcomes of transvenous lead removal in a single center, with the goal of using that scheme to guide electrophysiology lab versus operating room extraction.
  
  
  METHODS
  Consecutive patients undergoing transvenous lead removal from January 2001 to October 2012 at Mayo Clinic were retrospectively reviewed.
  
  
  RESULTS
  A total of 1,378 leads were removed from 652 (age 64 ± 17 years, M 68%) patients undergoing 702 procedures. Mean (standard deviation) lead age was 57.6 (58.8) months. Forty-four percent of leads required laser-assisted extraction. Lead duration (P < 0.001) and an implantable cardioverter defibrillator (ICD) lead (P < 0.001) were associated with the need for laser extraction and procedure failure (P < 0.0001 and P = 0.02). The major complication rate was 1.9% and was significantly associated with longer lead duration (odds ratio: 1.2, 95% confidence interval: 1.1-1.3; P < 0.001). High-risk patients (with a >10-year-old pacing or a >5-year-old ICD lead) had significantly higher major events than moderate-risk (with pacing lead 1-10 years old or ICD lead 1-5 years old) and low-risk (any lead ≤1-year-old) patients (5.3%, 1.2%, and 0%, respectively; P < 0.001).
  
  
  CONCLUSIONS
  Transvenous lead removal is highly successful, with few serious procedural complications. We propose a risk stratification scheme that may categorize patients as low, moderate, and high risk for lead extraction. Such a strategy may guide which extractions are best performed in the operating room.
authors: Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Henan, People's Republic of China.|Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Hai-Xia
authors: HX
authors: Fu
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.|Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Xin-Miao
authors: XM
authors: Huang
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.|Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors: L I
authors: LI
authors: Zhong
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Michael J
authors: MJ
authors: Osborn
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Samuel J
authors: SJ
authors: Asirvatham
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Raul E
authors: RE
authors: Espinosa
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Peter A
authors: PA
authors: Brady
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Hon-Chi
authors: HC
authors: Lee
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Larry M
authors: LM
authors: Baddour
authors: Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Rizwan M
authors: RM
authors: Sohail
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Nancy G
authors: NG
authors: Acker
authors: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors: David O
authors: DO
authors: Hodge
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Paul A
authors: PA
authors: Friedman
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Yong-Mei
authors: YM
authors: Cha
mesh_terms: D017677:Age Distribution; D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D017678:Sex Distribution; D015996:Survival Rate
keywords: cardiovascular implantable electronic device; complication; lead removal; outcome; survival