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Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.

Publication ,  Journal Article
Pokorney, SD; Mi, X; Lewis, RK; Greiner, M; Epstein, LM; Carrillo, RG; Zeitler, EP; Al-Khatib, SM; Hegland, DD; Piccini, JP
Published in: Circulation
October 2017

Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years; P<0.0001), were less likely to be male (65% versus 68%; P=0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years; P<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7-14.4) and 54.3% (95% CI, 52.8-55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62-0.97; P=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.

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Published In

Circulation

DOI

EISSN

1524-4539

ISSN

0009-7322

Publication Date

October 2017

Volume

136

Issue

15

Start / End Page

1387 / 1395

Related Subject Headings

  • United States
  • Survival Rate
  • Pacemaker, Artificial
  • Medicare
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Device Removal
  • Defibrillators, Implantable
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pokorney, S. D., Mi, X., Lewis, R. K., Greiner, M., Epstein, L. M., Carrillo, R. G., … Piccini, J. P. (2017). Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation, 136(15), 1387–1395. https://doi.org/10.1161/circulationaha.117.027636
Pokorney, Sean D., Xiaojuan Mi, Robert K. Lewis, Melissa Greiner, Laurence M. Epstein, Roger G. Carrillo, Emily P. Zeitler, Sana M. Al-Khatib, Donald D. Hegland, and Jonathan P. Piccini. “Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.Circulation 136, no. 15 (October 2017): 1387–95. https://doi.org/10.1161/circulationaha.117.027636.
Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, et al. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation. 2017 Oct;136(15):1387–95.
Pokorney, Sean D., et al. “Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.Circulation, vol. 136, no. 15, Oct. 2017, pp. 1387–95. Epmc, doi:10.1161/circulationaha.117.027636.
Pokorney SD, Mi X, Lewis RK, Greiner M, Epstein LM, Carrillo RG, Zeitler EP, Al-Khatib SM, Hegland DD, Piccini JP. Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. Circulation. 2017 Oct;136(15):1387–1395.

Published In

Circulation

DOI

EISSN

1524-4539

ISSN

0009-7322

Publication Date

October 2017

Volume

136

Issue

15

Start / End Page

1387 / 1395

Related Subject Headings

  • United States
  • Survival Rate
  • Pacemaker, Artificial
  • Medicare
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Device Removal
  • Defibrillators, Implantable