title: Outcomes of lead extraction without subsequent device reimplantation.
abstract: OBJECTIVE
  Outcomes among patients who do not receive device reimplantation after cardiovascular implantable electronic device (CIED) extraction have not been well studied. The present study aims to investigate the outcomes of patients without device reimplantation after lead extraction and device removal.
  
  
  RESULTS
  We retrospectively searched for consecutive patients who underwent CIED extraction at Mayo Clinic, Rochester, MN and University of California San Diego Medical Center from 2001 through 2012. Among the patients identified, we compared characteristics of those who did and did not have device reimplantation. The Kaplan-Meier survival was analysed. Among 678 patients, 97 patients had their device extracted without reimplantation during 1-year follow-up ('no-reimplant group'). Median age was younger in the no-reimplant group (60.7 vs. 70.6 years; P < 0.001). The reasons for no reimplantation were as follows: no longer meeting criteria for CIED (48%), inappropriate device indication at initial implantation (23%), patient preference (17%), and unresolved device complications (12%). Three major arrhythmias were reported in the no-reimplant group. Overall survival in the no-reimplant group was significantly lower than in the reimplant group (60 vs. 93%; P < 0.001). Ongoing device-related complications [hazard ratio (HR), 3.91; 95% CI, 1.74-8.81; P = 0.001], infection (HR, 3.06; 95% CI, 1.24-7.52; P = 0.02), and concurrent dialysis (HR, 2.74; 95% CI, 1.12-6.71; P = 0.03) were associated with increased mortality. Of 31 deaths in the no-reimplant group, 1 was secondary to cardiac arrhythmia.
  
  
  CONCLUSIONS
  Fourteen per cent of patients who had device extraction did not undergo reimplantation mainly because they no longer met CIED indications. The high mortality in these patients is related to device complications and comorbid conditions, whereas mortality associated with arrhythmia is rare.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Al-Hijji
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Ammar M
authors.initials: AM
authors.lastname: Killu
authors.affiliation: Division of Cardiovascular Medicine, University of San Diego Medical Center, La Jolla, San Diego, CA, USA.
authors.forename: Omid
authors.initials: O
authors.lastname: Yousefian
authors.affiliation: Biostatistics Unit, Mayo Clinic, Jacksonville, FA, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Jae Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Division of Cardiovascular Medicine, University of San Diego Medical Center, La Jolla, San Diego, CA, USA.
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Hebsur
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Abdallah
authors.initials: A
authors.lastname: El Sabbagh
authors.affiliation: Division of Cardiovascular Medicine, University of San Diego Medical Center, La Jolla, San Diego, CA, USA.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Pretorius
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Division of Cardiovascular Medicine, University of San Diego Medical Center, La Jolla, San Diego, CA, USA.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Birgersdotter-Green
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002140:California; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: CIED; Device extraction; Mortality