CRT patients undergoing lead extraction are at no higher risk than non-CRT patients

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Transvenous lead extraction in cardiac resynchronisation therapy (CRT) patients is not associated with increased 30-day mortality vs. non-CRT patients. The study found that age, renal impairment and sepsis were independent predictors of 30-day mortality and sepsis was the main cause of 30-day mortality.

The results of a 16-year single centre experience of transvenous lead and system extraction in patients with and without coronary sinus lead were presented by Justin Gould (Guy’s and St Thomas’ Hospital, London, UK and King’s College London, UK) at the European Heart Rhythm Association Congress (EHRA 2018; 18–20 March, Barcelona, Spain).

Transvenous lead extraction can be necessary for many reasons, such as system infection, erosion or lead malfunction. The study hypothesised that CRT patients with coronary sinus leads undergoing transvenous lead extraction are at a greater risk of major complications and 30-day mortality.

Data from all transvenous lead extractions carried out at Guy’s and St Thomas’ Hospital (London, UK) between 2001 and 2016 were prospectively collected and recorded onto a computer database and divided into two groups: CRT (n=227) and non-CRT (n=696). In total there were 923 patients in the database to compare. In the CRT group predominately had CRT defibrillators (78%, n=177) with CRT pacemakers making up 22% of the population (n=50). In the non-CRT group patients had predominantly either a dual chamber pacemaker (52%, n=363) or a single or dual chamber implantable cardiac defibrillator (ICD) (37%, n=257).

The patient demographics, with the exception of means age, previous valve surgery or stroke, comorbidities were significantly more prevalent in the CRT group, with 84% of the CRT group having two or more comorbidities and 63% having three or more.

Among the clinical features and indication for transvenous lead extraction the only statistically significant difference was mean lead dwell time, with the CRT group having an average dwell time of 5.6±5.5 years and the non CRT group having an average dwell time of 7.5±7.1 months (p=0.003). Gould speculated why this might be, saying: “It probably reflects the sicker cohort of patients, possibly earlier lead displacement in CRT patients as well.”

Major complication rates were exactly the same (2.2%) between the two groups and 30-day mortality was not statistically significantly different between the two groups, being 3.1% (n=7) for the CRT group and 2.4% (n=17) for the non-CRT group.

The predominant cause of 30-day mortality was sepsis in both groups (57%, n=4 in the CRT group vs. 53%, n=9 in the non-CRT group). The other causes of death were ventricular fibrillation arrest post transvenous lead extraction (n=1 in both CRT and non-CRT group), superior vena cava tear (n=1 in the non-CRT group), pneumonia (n=1 in the non-CRT group), and myocardial infarction (n=1 in the non-CRT group). There were two non-procedure related deaths in the CRT group and four non-procedure related deaths in the non-CRT group.

Analysis of these result found that CRT did not predict mortality using univariate and multivariate analysis.

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