Pacemaker Dependency and Outcomes of Tranvenous Lead Extraction - Data from the European ELECTRa Registry

Eran Leshem ^1,2 Guy Zahavi ^1,2 Maria Grazia Bongiorni ³ Angelo Auricchio ⁴ Christian Butter ⁵ Nikolaos Dagres ⁶ Jean-Claude Deharo ⁷ Michael Glikson ⁸ Roy Beinart ^1,2 Carina Blomström Lundqvist ⁹ Cécile Laroche ¹⁰ Eyal Nof ^1,2

¹Cardiology, Sheba Medical Center, Israel
²Sackler School of Medicine, Tel Aviv University, Israel
³Cardiology, Azienda Ospedaliero-Universitaria, Italy
⁴Cardiology, Fondazione Cardiocentro Ticino,, Switzerland
⁵Cardiology, Heart Center Brandenburg, Germany
⁶Electrophysiology, Heart Center Leipzig, Germany
⁷Cardiology, CHU La Timone, France
⁸Cardiology, Shaari Tsedek Medical Center, Israel
⁹Medical Science and Cardiology, Uppsala University, Sweden
¹⁰EURObservational Research Programme, European Society of Cardiology, France

Background:

Cardiac implantable electronic devices (CIED) tranvenous lead extraction (TLE) among patients that are pacemaker dependent is more cumbersome, as patients usually require a pacing solution during the procedure and following device extraction, increasing procedure complexity and duration. When infection is the driving reason for extraction, the overlap of temporary pacing until a new device can be implanted can result in lack of microorganism clearance and unfavorable outcomes.

Objective:

To explore the additive risk of TLE procedures associated with pacemaker dependency in a large international cohort.

Methods:

The ESC-EHRA-EORP ELECTRa registry included 3510 patients undergoing TLE. Patients were divided according to pacemaker dependency in both infectious vs. non-infectious cause for TLE. Peri-procedural complications and outcomes were analyzed.

Results:

Pacer dependency was common with 643 (18.4%) patients requiring temporary pacing during the procedure. Among TLE for an infectious reason, pacemaker dependency was more frequent than in non-infection etiologies [401/1865 (21%) vs 242/1634 (15%)]. Major complications were more prevalent among pacer dependent patients (3.7% vs 2.5%). Multivariate analysis revealed that longer lead dwell time, chronic kidney disease and obesity were predictive of procedural complications among pacer dependent patients. Mortality was not increased in pacer dependent patients, regardless of reason for TLE (p=0.39).

Conclusion:

The presence of a pacemaker dependency in patients undergoing TLE increases intra-operative complications, but is not associated with increased mortality for both infectious and non infectious driving causes for TLE.