title: Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry.
abstract: Patients with an unused or malfunctioning implantable cardioverter-defibrillator (ICD) lead may have the lead either abandoned or explanted; yet there are limited data on the comparative acute and longer-term safety of these 2 approaches.
  
  
  
  We examined in-hospital events among 24 908 subject encounters using propensity score 1:1 matching for ICD lead abandonment or explantation in the National Cardiovascular Data Registry (NCDR) ICD Registry (April 2010 to June 2014). Relative to patients undergoing lead abandonment, patients undergoing lead explantation had more in-hospital procedure-related complications: 2.19% (n=273) versus 3.77% (n=469; P<0.001), respectively. Similarly, patients undergoing lead explantation had slightly higher rates of in-hospital death: 0.21% (n=26) versus 0.64% (n=80; P<0.001), respectively. At 1 year in a Medicare subset for survival, there was a trend of increased mortality in the explantation group (11% versus 8%; P=0.06). In the Medicare subset analyzed for postprocedure complications, there was no difference with respect to 6-month bleeding (4.80% in both the groups), tamponade (0.38% versus 0.58%), infection (1.34% versus 3.07%), upper extremity thrombosis (0.77% versus 0.96%), pulmonary embolism (0.38% versus 0.96%), or urgent surgery (1.15% for both the groups; P>0.05 for all).
  
  
  
  After matching, patients undergoing removal of an unused or malfunctioning ICD lead had slightly higher in-hospital complications and deaths than those with a lead abandonment strategy. Although the 1-year mortality risk was slightly higher in the lead explantation group, this difference was not statistically significant and may be explained by chance.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Emily P
authors.initials: EP
authors.lastname: Zeitler
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.).
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., K.J.A., E.D.P., J.P.D., S.M.A.-K.); Department of Medicine, Duke University Medical System, Durham, NC (E.P.Z., E.D.P., J.P.D., S.M.A.-K.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, CT (Y.W., K.D., J.P.C.); and Department of Medicine, Yale University School of Medicine, New Haven, CT (Y.W., K.D., J.P.C.). alkha001@mc.duke.edu.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: implantable cardioverter defibrillator; medicare; survival analysis