title: Long-Term Outcomes Following Transvenous Lead Extraction.
abstract: BACKGROUND
  Complications related to a cardiac implantable electronic device sometimes require transvenous lead extraction (TLE). We report long-term follow-up of patients undergoing TLE, particularly mortality, recurrent device infection, and need for repeat procedures.
  
  
  RESULTS
  Consecutive patients undergoing TLE at a high-volume center were assessed for characteristics, indications, and outcomes. One thousand and six leads were extracted from 510 patients. Clinical success rate was 98.2% and complete procedural success was 92.2%, with one intraprocedural death. The mean follow-up was 5.5 +/- 4.9 years (range 0.2-18 years). Cumulative mortality was 3.3% at 30 days, 7.7% at 6 months, 10.0% at 1 year, and 33.0% at 10 years. Factors associated with increased long-term mortality included cardiac device infection (CDI; 33% vs 17% for non-CDI; χ² 13.8, P = 0.0003), procedural complications (43% vs 27% for no complications; χ² 4.2, P = 0.04), age (75.0 +/- 10.9 years in patients who died vs 62.7 +/- 17.2 years; P < 0.0001), and impaired renal function (creatinine 142.5 +/- 106.4 μmol/L in patients who died vs 106.3 +/- 90.7 μmol/L; P = 0.001). The rate of CDI after TLE was 3.9% (mean 11.6 months post extraction, range 0.3-84 months) and is higher in patients with retained lead fragments (13.5% vs 3.0% with complete removal; χ² 10.7, P = 0.001).
  
  
  CONCLUSIONS
  Long-term mortality following TLE is high, particularly in those with systemic infection, procedural complications, advanced age, and renal impairment. Retained fragments are a risk factor for CDI post extraction.
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Gomes
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cranney
authors.affiliation: Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Giles
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002406:Catheterization, Peripheral / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D020878:Device Removal / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000600:supply & distribution*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: infection; internal cardioverter defibrillator; lead extraction; pacemaker