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Non-infected lead extractions: a better long-term solution?
Session:
SESSÃO DE POSTERS 45 - DISPOSITIVOS CARDÍACOS IMPLANTÁVEIS: COMPLICAÇÕES E SUA PREVENÇÃO
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida G. Figueiredo; André Ferreira; Hélder Santos; Guilherme Portugal; Paulo Osório; Ana Lousinha; Pedro Silva Cunha; Bruno Valente; Rui Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> In recent years, as a result of an increasing number of cardiac implanted electronic devices (CIED), the number of CIED related complications has increased and solutions to complex CIED procedures in high risk patients (P) are required. Transvenous lead extractions (LE) can be the best solution for some of these patients. The "Pisa Technique" (PT) is an increasingly used method of LE, being associated with the lowest rate of complications. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>We aim to understand the safety of LE and long-term follow-up in P without CIED infection. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-centre prospective analysis engaging P that underwent LE. P were divided into two groups: Group A – P without CIED associated infections – and Group B – P with CIED infection. Efficacy and safety of LE were analysed. Kaplan-Meier test was performed to establish survival rates in terms of one-year major adverse cardiac event (MACE), mortality and hospital readmissions for all causes. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of 257 P underwent LE, 52 (20%) in group A and 205 (80%) in group B, with a total of 455 leads removed, 17% in group A and 83% in group B. In group A, LE was due to non-functional leads in 56% of P, system upgrading in 12% (absence of venous access), lead dislodgement in 8%, cardiac perforation in 8%, malignancy treatment in 4%, lead fracture in 2% and chronic pain in 2%. In 1 P LE was needed due to superior vena cava syndrome, in another one LE was performed due to twiddler syndrome and there was 1 P in which the PT was performed to remove a dialysis catheter. All the extractions in group A were performed using the PT. Median follow-up time was 35 (IQR 17-82) months. Median age in group A was 61 (IQR 41-74) vs 75 (IQR 62-82) years in group B (p<0.001), 25% of P had left ventricular (LV) dysfunction (LV ejection fraction <50%) vs 20% (p=0.125) and median lead dwell time was 60 (IQR 28-96) vs 84 (IQR 36-132) months (p=0.102). In group A there were 23% of passive fixation leads vs 48% (p=0.001) and there was the need of using more than one sheet in 27% of P vs 33% (p=0.388). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results regarding efficacy, clinical and radiological success of LE were present in 92% of P in group A and in 94% of P in group B (p=0.726). In which concerns safety, there were no procedure complications in group A vs 8% in group B (p=0.037), while complications or death during hospitalisation were present in 2% of P in group A and 11% in group B (p=0.046). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Kaplan Meier test showed no statistically significant differences in terms of one-year MACE (Figure 1A), long-term rehospitalization (Figure 1B), or mortality (Figure 1C). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our study, non-infected LE using the PT showed to be as effective and safe as LE in CIED infections, not only in the short-term with less complications or death during hospitalisation, but also during long-term follow-up after LE. Besides, this is the first national study that suggests that non-infected LE may be a solution to a variety situations and can be a fair option in the long-term follow up. </span></span></p>
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