title: Procedural outcomes and long-term survival following trans-venous defibrillator lead extraction in patients with end-stage renal disease.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) increases the risk of implantable cardioverter-defibrillator (ICD) infection. We sought to define outcomes of lead extraction in patients with ESRD.
  
  
  RESULTS
  Implantable cardioverter-defibrillator lead extractions at our institution from January 2006 to March 2014 were stratified by absence (Control-Ex, n = 465) or presence (ESRD-Ex, n = 43) of ESRD. Procedural outcomes and survival were determined by medical records review. Survival in the ESRD-Ex group was compared with a contemporaneous cohort with ESRD undergoing ICD lead implantation (ESRD-I, n = 127). Among extraction patients, those with ESRD were more likely to be extracted for infection (74.4% vs. 28.6%, P < 0.001). Extraction procedure success (Control-Ex: 97% vs. ESRD-Ex: 93%, P = 0.17) and procedural deaths (Control-Ex: 1.1% vs. ESRD-Ex: 2.3%, P = 0.413) were similar. Survival 1 year following extraction was worse in the ESRD-Ex group compared with the Control-Ex, with a survival rate of 65.6% vs. 92.6% (P < 0.001); these curves continued to diverge through year 3. One-year survival in the ESRD-Ex group was worse than among ESRD patients undergoing ICD implant (ESRD-I), but these curves converged and survival was similar by year 3.
  
  
  CONCLUSIONS
  Implantable cardioverter-defibrillator lead extraction can be performed safely and effectively in patients with ESRD. However, despite high rates of procedural success, long-term mortality following extraction in ESRD patients is substantial. Much of the long-term mortality risk appears to be accounted for by the presence of ESRD and an indication for an ICD.
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Anand D
authors.initials: AD
authors.lastname: Shah
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Lakshmi P
authors.initials: LP
authors.lastname: Peddareddy
authors.affiliation: Boston Scientific Corporation, 300 Boston Scientific Way, Malborough, MA 01752, USA.
authors.forename: Maher A
authors.initials: MA
authors.lastname: Addish
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kelly
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Adarsh U
authors.initials: AU
authors.lastname: Patel
authors.affiliation: Cardiology Division, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Casey
authors.affiliation: Cardiology Division, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
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, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.affiliation: Cardiology Division (Section of Cardiac Electrophysiology), Department of Medicine, Emory University School of Medicine, 550 Peachtree Street, MOT 6th floor, Atlanta, GA 30308, USA.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
mesh_terms: D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005845:Georgia; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Dialysis; End stage renal disease; Implantable cardioverter-defibrillator; Lead extraction