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Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry.

Publication ,  Journal Article
Zeitler, EP; Wang, Y; Dharmarajan, K; Anstrom, KJ; Peterson, ED; Daubert, JP; Curtis, JP; Al-Khatib, SM
Published in: Circ Arrhythm Electrophysiol
July 2016

BACKGROUND: Patients with an unused or malfunctioning implantable cardioverter-defibrillator (ICD) lead may have the lead either abandoned or explanted; yet there are limited data on the comparative acute and longer-term safety of these 2 approaches. METHODS AND RESULTS: We examined in-hospital events among 24 908 subject encounters using propensity score 1:1 matching for ICD lead abandonment or explantation in the National Cardiovascular Data Registry (NCDR) ICD Registry (April 2010 to June 2014). Relative to patients undergoing lead abandonment, patients undergoing lead explantation had more in-hospital procedure-related complications: 2.19% (n=273) versus 3.77% (n=469; P<0.001), respectively. Similarly, patients undergoing lead explantation had slightly higher rates of in-hospital death: 0.21% (n=26) versus 0.64% (n=80; P<0.001), respectively. At 1 year in a Medicare subset for survival, there was a trend of increased mortality in the explantation group (11% versus 8%; P=0.06). In the Medicare subset analyzed for postprocedure complications, there was no difference with respect to 6-month bleeding (4.80% in both the groups), tamponade (0.38% versus 0.58%), infection (1.34% versus 3.07%), upper extremity thrombosis (0.77% versus 0.96%), pulmonary embolism (0.38% versus 0.96%), or urgent surgery (1.15% for both the groups; P>0.05 for all). CONCLUSIONS: After matching, patients undergoing removal of an unused or malfunctioning ICD lead had slightly higher in-hospital complications and deaths than those with a lead abandonment strategy. Although the 1-year mortality risk was slightly higher in the lead explantation group, this difference was not statistically significant and may be explained by chance.

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Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

July 2016

Volume

9

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Propensity Score
  • Postoperative Complications
  • Middle Aged
  • Male
 

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Zeitler, E. P., Wang, Y., Dharmarajan, K., Anstrom, K. J., Peterson, E. D., Daubert, J. P., … Al-Khatib, S. M. (2016). Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol, 9(7). https://doi.org/10.1161/CIRCEP.116.003953
Zeitler, Emily P., Yongfei Wang, Kumar Dharmarajan, Kevin J. Anstrom, Eric D. Peterson, James P. Daubert, Jeptha P. Curtis, and Sana M. Al-Khatib. “Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry.Circ Arrhythm Electrophysiol 9, no. 7 (July 2016). https://doi.org/10.1161/CIRCEP.116.003953.
Zeitler, Emily P., et al. “Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry.Circ Arrhythm Electrophysiol, vol. 9, no. 7, July 2016. Pubmed, doi:10.1161/CIRCEP.116.003953.
Zeitler EP, Wang Y, Dharmarajan K, Anstrom KJ, Peterson ED, Daubert JP, Curtis JP, Al-Khatib SM. Outcomes 1 Year After Implantable Cardioverter-Defibrillator Lead Abandonment Versus Explantation for Unused or Malfunctioning Leads: A Report from the National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol. 2016 Jul;9(7).

Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

July 2016

Volume

9

Issue

7

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Propensity Score
  • Postoperative Complications
  • Middle Aged
  • Male