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American Heart Association

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Final ID: MDP1767

Transvenous Lead Extraction Outcomes in Hemodialysis Patients: Assessing the Risk of Infection

Abstract Body (Do not enter title and authors here): Introduction: CIED implant volume remains high, leading to an increase in TLE (Transvenous Lead Extraction) procedures to manage a growing population with aging leads. However, data on TLE outcomes for dialysis patients is limited.
Aims: To determine if dialysis patients in the current era have worse outcomes after TLE (procedural success rate, major complications, and 30-day all-cause mortality (ACM)); and to find predictors for the same.
Methods: We included all TLE procedures at our institution between 2013-2022 (n=1614; dialysis=53; non-dialysis=1561). Data was collected retrospectively from electronic medical records. Outcomes were first analyzed for all patients; followed by subgroup analyses for dialysis patients with infection, since that was the most common indication for TLE (48/53; 90.6%). Within the subgroup, we looked at intracardiac mass on echo, positive blood culture, and pocket infection as predictors.
Results: Mean age of our sample was 62.3 years and 66.8% were male. Lead age and combined lead age were significantly different between dialysis and non-dialysis patients (8.8 vs 5.6 years; p<0.001, and 11.1 vs 16.5 years; p=0.02). Success rate and major complications rate was similar (96.2% vs 95.5%; p=0.8, and 3.8% vs 2.1%; p=0.4), but 30-day ACM rates were significantly worse among dialysis patients (13.2% vs 2%; p<0.001). Multivariate analysis found dialysis, lead extraction due to infection, and NYHA Class 3 or 4 to be independent predictors of 30-day ACM among the entire study population (Table 1). Within the subgroup, only intracardiac mass was associated with significantly worse 30-day ACM (33.1% vs 6.1%; p=0.01), which was confirmed with multivariate analysis [OR=22.4 (1.8-280.4); p=0.02] (Table 2).
Conclusion: Dialysis is an independent predictor of 30-day ACM after TLE, along with lead extraction due to infection, and NYHA Class 3 or 4. Within the subgroup of dialysis patients with infection, visualization of intracardiac mass on echo is a predictor of 30-day ACM.
  • Paul, Aritra  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Callahan, Thomas  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Hayashi, Katsuhide  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Baranowski, Bryan  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Kochar, Arshneel  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Martin, David  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Taigen, Tyler  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Rickard, John  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Hussein, Ayman  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Wazni, Oussama  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Author Disclosures:
    Aritra Paul: DO NOT have relevant financial relationships | Thomas Callahan: DO have relevant financial relationships ; Speaker:Medtronic:Active (exists now) ; Consultant:Merritt:Past (completed) ; Consultant:Shockwave:Past (completed) ; Speaker:Boston Scientific:Active (exists now) ; Speaker:Abbott:Active (exists now) ; Speaker:Philips:Active (exists now) | Katsuhide Hayashi: No Answer | Bryan Baranowski: DO NOT have relevant financial relationships | Arshneel Kochar: DO NOT have relevant financial relationships | David Martin: No Answer | Tyler Taigen: DO have relevant financial relationships ; Consultant:Medtronic:Active (exists now) ; Consultant:Biosense Webster:Active (exists now) ; Consultant:Boston Scientific:Active (exists now) | John Rickard: No Answer | Ayman Hussein: No Answer | Oussama Wazni: DO have relevant financial relationships ; Consultant:boston scientific:Active (exists now) ; Speaker:Boston Scientific:Past (completed)
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Out Out Damned Spot! Adventures in Lead Extraction

Monday, 11/18/2024 , 11:10AM - 12:35PM

Moderated Digital Poster Session

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