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Transvenous lead extraction in patients with systemic cardiac device–related infection—Procedural outcome and risk prediction: A GALLERY subgroup analysis

Published:October 11, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.004

      Background

      Transvenous lead extraction (TLE) has evolved as one of the most crucial treatment options for patients with cardiac device–related systemic infection (CDRSI).

      Objective

      The aim of this study was to characterize the procedural outcome and risk factors of patients with CDRSI undergoing TLE.

      Methods

      A subgroup analysis of patients with CDRSI of the GALLERY (GermAn Laser Lead Extraction RegistrY) database was performed. Predictors for complications, procedural failure, and all-cause mortality were evaluated.

      Results

      A total of 722 patients (28.6%) in the GALLERY had “systemic infection” as extraction indication. Patients with CDRSI were older (70.1 ± 12.2 years vs 67.3 ± 14.3 years; P < .001) and had more comorbidities than patients with local infections or noninfectious extraction indications. There were no differences in complete procedural success (90.6% vs 91.7%; P = .328) or major complications (2.5% vs 1.9%; P = .416) but increased procedure-related (1.4% vs 0.3%; P = .003) and all-cause in-hospital mortality (11.1% vs 0.6%; P < .001) for patients with CDRSI. Multivariate analyses revealed lead age ≥10 years as a predictor for procedural complications (odds ratio [OR] 3.23; 95% confidence interval [CI] 1.58–6.60; P = .001). Lead age ≥10 years (OR 2.57; 95% CI 1.03–6.46; P = .04) was also a predictor for procedural failure. We identified left ventricular ejection fraction <30% (OR 1.70; 95% CI 1.00–2.99; P = .049), age ≥75 years (OR 2.1; 95% CI 1.27–3.48; P = .004), chronic kidney disease (OR 1.92; 95% CI 1.17–3.14; P = .01), and overall procedural complications (OR 5.15; 95% CI 2.44–10.84; P < .001) as predictors for all-cause mortality.

      Conclusion

      Patients with CDRSI undergoing TLE demonstrate an increased rate of all-cause in-hospital, as well as procedure-related mortality, despite having comparable procedural success rates. Given these data, it seems paramount to develop preventive strategies to detect and treat CDRSI in its earliest stages.

      Graphical abstract

      Keywords

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