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Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy

Author

Listed:
  • Paweł Stefańczyk

    (Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland)

  • Dorota Nowosielecka

    (Department of Cardiology, Pope John Paul II Province Hospital, 22-400 Zamość, Poland
    Department of Cardiac Surgery, Pope John Paul II Province Hospital, 22-400 Zamość, Poland)

  • Anna Polewczyk

    (Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
    Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland)

  • Wojciech Jacheć

    (2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Medical University in Katowice, 41-800 Zabrze, Poland)

  • Andrzej Głowniak

    (Department of Cardiology, Medical University, 20-059 Lublin, Poland)

  • Jarosław Kosior

    (Department of Cardiology, Masovian Specialist Hospital, 26-617 Radom, Poland)

  • Andrzej Kutarski

    (Department of Cardiology, Medical University, 20-059 Lublin, Poland)

Abstract

Background: Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. Methods: We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. Results: The need for an upgrade was the leading indication for TLE in only 36–66% of patients. In 42.0–57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1–76.4% of patients, functional leads were retained in 20.2–31.9%, non-functional leads were left in place in 0.0–1.1%, and non-functional superfluous leads were extracted in 3.6–8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Conclusions: Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death.

Suggested Citation

  • Paweł Stefańczyk & Dorota Nowosielecka & Anna Polewczyk & Wojciech Jacheć & Andrzej Głowniak & Jarosław Kosior & Andrzej Kutarski, 2022. "Efficacy and Safety of Transvenous Lead Extraction at the Time of Upgrade from Pacemakers to Cardioverter-Defibrillators and Cardiac Resynchronization Therapy," IJERPH, MDPI, vol. 20(1), pages 1-16, December.
    • Handle: RePEc:gam:jijerp:v:20:y:2022:i:1:p:291-:d:1013982
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    References listed on IDEAS

    as
    1. Łukasz Tułecki & Anna Polewczyk & Wojciech Jacheć & Dorota Nowosielecka & Konrad Tomków & Paweł Stefańczyk & Jarosław Kosior & Krzysztof Duda & Maciej Polewczyk & Andrzej Kutarski, 2021. "Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage," IJERPH, MDPI, vol. 18(17), pages 1-13, August.
    2. Marek Czajkowski & Wojciech Jacheć & Anna Polewczyk & Jarosław Kosior & Dorota Nowosielecka & Łukasz Tułecki & Paweł Stefańczyk & Andrzej Kutarski, 2021. "The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction," IJERPH, MDPI, vol. 18(18), pages 1-17, September.
    3. Łukasz Tułecki & Anna Polewczyk & Wojciech Jacheć & Dorota Nowosielecka & Konrad Tomków & Paweł Stefańczyk & Jarosław Kosior & Krzysztof Duda & Maciej Polewczyk & Andrzej Kutarski, 2021. "A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers," IJERPH, MDPI, vol. 18(19), pages 1-13, October.
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