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

Sean D. Pokorney, Xiaojuan Mi, Robert K. Lewis, Melissa Greiner, Laurence M. Epstein, Roger Carrillo, Emily P. Zeitler, Sana M. Al-Khatib, Donald D. Hegland, Jonathan P. Piccini

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)1387-1395
Number of pages9
JournalCirculation
Volume136
Issue number15
DOIs
StatePublished - Oct 10 2017

Keywords

  • defibrillators, implantable
  • infection
  • Medicare
  • mortality
  • pacemaker, artificial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Pokorney, S. D., Mi, X., Lewis, R. K., Greiner, M., Epstein, L. M., Carrillo, R., Zeitler, E. P., Al-Khatib, S. M., Hegland, D. D., & 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