Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis
BackgroundThe 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 individual...
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| Format: | Article |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1251055/full |
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| author | Enida Rexha Da-Un Chung Heiko Burger Naser Ghaffari Tomas Madej Virgilijus Ziaukas Kambiz Hassan Hermann Reichenspurner Hermann Reichenspurner Nele Gessler Nele Gessler Stephan Willems Stephan Willems Christian Butter Simon Pecha Samer Hakmi Samer Hakmi |
| author_facet | Enida Rexha Da-Un Chung Heiko Burger Naser Ghaffari Tomas Madej Virgilijus Ziaukas Kambiz Hassan Hermann Reichenspurner Hermann Reichenspurner Nele Gessler Nele Gessler Stephan Willems Stephan Willems Christian Butter Simon Pecha Samer Hakmi Samer Hakmi |
| author_sort | Enida Rexha |
| collection | DOAJ |
| description | BackgroundThe 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.ObjectiveThe 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.MethodsAll 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.ResultsWe 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.ConclusionTLE 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. |
| first_indexed | 2024-03-12T02:09:26Z |
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| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-12T02:09:26Z |
| publishDate | 2023-09-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-a6ab5c3976b54104bdd17e3e919d27a62023-09-06T16:57:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-09-011010.3389/fcvm.2023.12510551251055Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysisEnida Rexha0Da-Un Chung1Heiko Burger2Naser Ghaffari3Tomas Madej4Virgilijus Ziaukas5Kambiz Hassan6Hermann Reichenspurner7Hermann Reichenspurner8Nele Gessler9Nele Gessler10Stephan Willems11Stephan Willems12Christian Butter13Simon Pecha14Samer Hakmi15Samer Hakmi16Department of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, GermanyDepartment of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, GermanyDepartment of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, GermanyDepartment of Cardiovascular Surgery, Helios Clinic for Heart Surgery, Karlsruhe, GermanyDepartment of Cardiac Surgery, University Heart Center Dresden, Dresden, GermanyDepartment of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, GermanyDepartment of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, GermanyDepartment of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, GermanyDepartment of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, GermanyDepartment of Cardiology and Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, GermanyDepartment of Cardiology, Heart Center Brandenburg Bernau, Neuruppin, GermanyDepartment of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, GermanyBackgroundThe 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.ObjectiveThe 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.MethodsAll 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.ResultsWe 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.ConclusionTLE 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.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1251055/fulltransvenous lead extractioncardiac implantable electronic devicelead managementyoung adultsoutcomesrisk factors |
| spellingShingle | Enida Rexha Da-Un Chung Heiko Burger Naser Ghaffari Tomas Madej Virgilijus Ziaukas Kambiz Hassan Hermann Reichenspurner Hermann Reichenspurner Nele Gessler Nele Gessler Stephan Willems Stephan Willems Christian Butter Simon Pecha Samer Hakmi Samer Hakmi Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis Frontiers in Cardiovascular Medicine transvenous lead extraction cardiac implantable electronic device lead management young adults outcomes risk factors |
| title | Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis |
| title_full | Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis |
| title_fullStr | Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis |
| title_full_unstemmed | Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis |
| title_short | Procedural outcome & risk prediction in young patients undergoing transvenous lead extraction—a GALLERY subgroup analysis |
| title_sort | procedural outcome risk prediction in young patients undergoing transvenous lead extraction a gallery subgroup analysis |
| topic | transvenous lead extraction cardiac implantable electronic device lead management young adults outcomes risk factors |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1251055/full |
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