High recurrence of device-related adverse events following transvenous lead extraction procedure in patients with cardiac resynchronization devices.

摘要: Introduction Little is known about the clinical outcome and recurring system-related adverse events (SAE) in cardiac resynchronization therapy (CRT) patients after transvenous lead extraction (TLE). Methods results From January 2009 to June 2014, 256 consecutive CRT (mean age 68.3 ± 11.6 years, 216 male, 88% New York Heart Association class II–IV, ejection fraction 35.1 ± 10.8%) were treated at four European institutions with TLE. Indications for TLE included systemic (18%) or local (45%) infection, system malfunction (34%), other (3%). Demographic, clinical, procedural, follow-up data collected retrospectively. Adverse (AE) considered as death from any cause, cardiovascular hospitalization, SAE (SAE pocket and/or malfunction, haematoma requiring revision). Complete removal was achieved 607 out of 614 leads (98.9%) by using either manual traction (29%), mechanical (43%) laser (28%) sheaths. Over a median 21 (interquartile range 12–29) months, cumulative incidences AE 39.8% 21.5%, respectively. Recurring occurred 23 (9.0%), infection 17 (6.6%), revision 15 (5.9%). Oral anticoagulation an independent predictor both [hazard ratio (HR) 2.09, 95% confidence interval (CI) 1.35–3.22, P < 0.001] (HR 2.38, CI 1.21–4.68, P = 0.012) TLE. Conclusions Even though safe effective treat patients, high burden observed mid-term follow-up. Careful evaluation patient characteristics well implantation strategy suggested when indicating patient, particularly receiving oral therapy.