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. 2024 Sep-Oct;24(5):263-270.
doi: 10.1016/j.ipej.2024.07.001. Epub 2024 Jul 9.

Long- and short-term outcomes after transvenous lead extraction in a large single-centre patient cohort using the clinical frailty scale as a risk assessment tool

Ava Azari  1 , Ingibjörg Kristjánsdóttir  2 , Paolo Gatti  3 , Andreas Berge  4 , Fredrik Gadler  2
Affiliations

Long- and short-term outcomes after transvenous lead extraction in a large single-centre patient cohort using the clinical frailty scale as a risk assessment tool

Ava Azari et al. Indian Pacing Electrophysiol J. 2024 Sep-Oct.

Abstract

Background and aims: The rate of cardiac implantable electronic device (CIED) implantations and the need for transvenous lead extraction (TLE) are growing worldwide. This study examined a large Swedish cohort with the aim of identifying possible predictors of post-TLE mortality with special focus on systemic infection patients and frailty.

Methods: This was a single centre study. Records of patients undergoing TLE between 2010 and 2018 were analysed. Statistical analyses were conducted to compare baseline characteristics of patients with different indications and identify risk factors of 30-day and 1-year mortality.

Results: A total of 893 patients were identified. Local infection was the dominant indication and pacemaker was the most common CIED. The mean age was 65 ± 16 years, 73 % were male and median follow-up was 3.9 years. Heart failure was the most common comorbidity. Patients with systemic infection were significantly older, frailer and had significantly higher levels of comorbidities. 30-day mortality and 1-year mortality rates were 2.5 % and 9.9 %, respectively. Systemic infection and chronic kidney disease (CKD) were independently associated with 30-day and 1-year mortality. Clinical frailty scale (CFS) 5-7 correlated independently with 1-year mortality in the entire cohort and specifically in systemic infection patients. CKD, cardiac resynchronization therapy and CFS 5-7 were significant risk factors for long-term mortality (death >1 year after TLE) in multivariable analysis.

Conclusions: Systemic infection, kidney failure in addition to the novel parameter of frailty were associated with post-TLE all-cause mortality. These risk factors should be considered during pre-procedure risk stratification to improve post-TLE outcomes.

Keywords: Cardiac implantable electronic devices; Frailty; Infection; Lead management; Transvenous lead extraction.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Kaplan-Meier curves stratified by TLE-indications (a), CRT vs non-CRT (b), CFS 5–7 vs CFS 1–4 (c) and CKD vs non-CKD (d). Kaplan-Meier curves for TLE-indications start from day 60 after extraction (a). Kaplan-Meier curves for CFS were constructed for patients undergoing TLE between 2015 and 2018 (c) CFS, Clinical frailty scale; CKD, chronic kidney disease; CRT, cardiac resynchronization therapy; OR, odds ratio; TLE, transvenous lead extraction.
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