Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction-a GALLERY subgroup analysis

Enida Rexha; Da-Un Chung; Heiko Burger; Naser Ghaffari; Tomas Madej; Virgilijus Ziaukas; Kambiz Hassan; Hermann Reichenspurner; Nele Gessler; Stephan Willems; Christian Butter; Simon Pecha; Samer Hakmi

doi:10.3389/fcvm.2023.1251055

Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction-a GALLERY subgroup analysis

Front Cardiovasc Med. 2023 Sep 6:10:1251055. doi: 10.3389/fcvm.2023.1251055. eCollection 2023.

Authors

Enida Rexha^#¹, Da-Un Chung^#¹, Heiko Burger², Naser Ghaffari³, Tomas Madej⁴, Virgilijus Ziaukas⁵, Kambiz Hassan⁶, Hermann Reichenspurner^{7

8}, Nele Gessler^{1

8}, Stephan Willems^{1

8}, Christian Butter⁹, Simon Pecha⁷, Samer Hakmi^{6

8}

Affiliations

¹ Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
² Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
³ Department of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, Germany.
⁴ Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
⁵ Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany.
⁶ Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
⁷ Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁸ DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
⁹ Department of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, Germany.

^# Contributed equally.

Abstract

Background: The prevalence of young patients with cardiac implantable electronic devices (CIED) is steadily increasing, accompanied by a rise in the occurrence of complications related to CIEDs. Consequently, transvenous lead extraction (TLE) has become a crucial treatment approach for such individuals.

Objective: The purpose of this study was to examine the characteristics and procedural outcomes of young patients who undergo TLE, with a specific focus on identifying independent risk factors associated with adverse events.

Methods: All patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) were categorized into two groups based on their age at the time of enrollment: 45 years or younger, and over 45 years. A subgroup analysis was conducted specifically for the younger population. In this analysis, predictor variables for all-cause mortality, procedural complications, and procedural failure were evaluated using multivariable analyses.

Results: We identified 160 patients aged 45 years or younger with a mean age of 35.3 ± 7.6 years and 42.5% (n = 68) female patients. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2 ± 1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. The all-cause in-hospital mortality rate was 2.5%, with septic shock identified as the primary cause of mortality. Multivariable analysis revealed CKD (OR: 19.0; 95% CI: 1.84-194.9; p = 0.018) and systemic infection (OR: 12.7; 95% CI: 1.14-142.8; p = 0.039) as independent predictor for all-cause mortality. Lead age ≥ 10 years (OR: 14.58, 95% CI: 1.36-156.2; p = 0.027) was identified as sole independent risk factor for procedural complication.

Conclusion: TLE in young patients is safe and effective with a procedure-related mortality rate of 0.0%. CKD and systemic infection are predictors for all-cause mortality, whereas lead age ≥ 10 years was identified as independent risk factor for procedural complications in young patients undergoing TLE.

Keywords: cardiac implantable electronic device; lead management; outcomes; risk factors; transvenous lead extraction; young adults.