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Previously abandoned cardiac-device leads associated with complications, infections
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Worse clinical outcomes and complications in the management of cardiac-device infections were linked to previously abandoned leads, according to findings published in JACC: Clinical Electrophysiology.
Ayman A. Hussein, MD, of the department of cardiovascular medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, and colleagues assessed the effect of previously abandoned leads on the clinical management of cardiac-device infections, particularly transvenous lead extraction and resulting clinical methods.
The researchers analyzed data from 1,386 patients who underwent percutaneous extraction of infected cardiac devices at Cleveland Clinic between August 1996 and September 2012. Total procedural and clinical success categorized as the removal of the device and all lead material from the vascular space without a major complication served as the primary clinical endpoint.
Transvenous lead extraction complications were defined in two ways — major complications were those that were life-threatening, produced death or significant or permanent disability, or required surgical intervention; minor complications were those needing standard medical or minor procedural interventions.
Patients were grouped according to whether they had previously abandoned leads (n = 323) or did not (n = 1,063). Among those with infected cardiac devices, 23.3% had previously abandoned leads.
Patients with abandoned leads failed to reach the primary endpoint more often (13% vs. 3.7%; P < .0001), driven by retention of lead material (11.5% vs. 2.9%; P < .0001).
Failure to reach the primary endpoint was linked to poor clinical outcomes such as higher rates of 1-month mortality (7.4% vs. 3.5%), according to the researchers.
Longer fluoroscopy times (P < .0001), a higher likelihood of the need for specialized extraction tools (94.4% vs. 81.8%; P < .0001) or adjunctive rescue femoral workstations (14.9% vs. 2.9%; P < .0001), and longer extraction procedure times (P < .0001) were seen in patients with previously abandoned leads vs. those without.
Also, patients with previously abandoned leads experienced more frequent overall procedural complications (11.5% vs. 5.6%; P = .0003) in both the major (3.7% vs. 1.4%; P = .009) and minor (7.7% vs. 4.4%; P = .02) ranges. – by James Clark
Disclosure: The researchers report no relevant financial disclosures.
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