Predictors of perforation during lead extraction: Results of the Canadian Lead ExtrAction Risk (CLEAR) study,Heart Rhythm

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Predictors of perforation during lead extraction: Results of the Canadian Lead ExtrAction Risk (CLEAR) study
Heart Rhythm ( IF 5.6 ) Pub Date : 2021-10-22 , DOI: 10.1016/j.hrthm.2021.10.019
Jamil Bashir ₁ , Arthur J Lee ₁ , Francois Philippon ₂ , Blandine Mondesert ₃ , Andrew D Krahn ₁ , Mouhannad M Sadek ₄ , Derek Exner ₅ , Melissa Pak ₁ , Jean Francois Legare ₆ , Shahzad Karim ₁ , Lynn Fedoruk ₁ , Defen Peng ₁ , Robert J Cusimano ₇ , Ratika Parkash ₆ , G Frank O Tyers ₁ , Jason Andrade ₁

Affiliation

Background

Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized.

Objective

The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population.

Methods

We performed a retrospective multicenter study examining patients undergoing lead extraction at 8 Canadian institutions from 1996 through 2016. Demographic and clinical data were used to identify variables associated with perforation and mortality using logistic regression modeling.

Results

A total of 2325 consecutive patients (age 61.9 ±16.5 years) underwent extraction of 4527 leads. Perforation rate was 2.7% (63/2325) and 30-day mortality was 1.6% (38/2325), with mortality of 0.4% due to perforation (10/2325). Variables associated with perforation included no previous cardiac surgery (odds ratio [OR] 3.33; 95% confidence interval [CI] 1.54–7.19; P = .002), female sex (OR 3.27; 95% CI 1.91–5.60; P <.001); left ventricular ejection fraction ≥40% (OR 2.81; 95% CI 1.28–6.14; P = .010); lead age >8 years (OR 2.64; 95% CI 1.52–4.60; P <.001); ≥2 leads extracted (OR 2.49; 95% CI 1.23–5.04; P = .011); and diabetes (OR 2.12; 95% CI 1.16–3.86; P = .014). Variables associated with death included infection as indication for extraction (OR 3.85; 95% CI 1.38–10.73; P = .010); anemia (OR 3.14; 95% CI 1.38–6.61; P = .003), and patient age (OR 1.04; 95% CI 1.01–1.07; P = .012).

Conclusion

Risk factors associated with perforation in lead extraction include no history of cardiac surgery, female sex, preserved left ventricular ejection fraction, lead age >8 years, ≥2 leads extracted, and diabetes.

中文翻译：

铅提取过程中穿孔的预测因素：加拿大铅提取风险 (CLEAR) 研究的结果

背景

经静脉导线拔除可能会产生严重的不良事件，例如心脏或血管穿孔。风险因素尚未得到很好的表征。

客观的

本研究的目的是确定与穿孔和死亡相关的因素，并在大量当代人群中描述铅提取的特征。

方法

我们进行了一项回顾性多中心研究，检查 1996 年至 2016 年期间在 8 家加拿大机构接受导线拔除的患者。使用人口统计学和临床数据，使用逻辑回归模型确定与穿孔和死亡率相关的变量。

结果

共有 2325 名连续患者（年龄 61.9 ±16.5 岁）接受了 4527 条导联的拔除。穿孔率为 2.7% (63/2325)，30 天死亡率为 1.6% (38/2325)，穿孔死亡率为 0.4% (10/2325)。与穿孔相关的变量包括以前没有心脏手术（优势比 [OR] 3.33；95% 置信区间 [CI] 1.54–7.19；P = .002），女性（OR 3.27；95% CI 1.91–5.60；P <. 001); 左心室射血分数 ≥40%（OR 2.81；95% CI 1.28–6.14；P = .010）；领先年龄 >8 岁（OR 2.64；95% CI 1.52–4.60；P <.001）；≥2 导联提取（OR 2.49；95% CI 1.23–5.04；P = .011）；和糖尿病（OR 2.12；95% CI 1.16–3.86；P= .014)。与死亡相关的变量包括作为拔除指征的感染（OR 3.85；95% CI 1.38–10.73；P = .010）；贫血（OR 3.14；95% CI 1.38–6.61；P = .003）和患者年龄（OR 1.04；95% CI 1.01–1.07；P = .012）。