1. Procedural outcomes and long-term survival following trans-venous defibrillator lead extraction in patients with end-stage renal disease.
- Author
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Shah, Anand D., Peddareddy, Lakshmi P., Addish, Maher A., Kelly, Kimberly, Patel, Adarsh U., Casey, Mary, Goyal, Abhinav, Leon, Angel R., El-Chami, Mikhael F., and Merchant, Faisal M.
- Subjects
CHRONIC kidney failure complications ,CHRONIC kidney failure ,COMPARATIVE studies ,ELECTRIC countershock ,IMPLANTABLE cardioverter-defibrillators ,INFECTION ,RESEARCH methodology ,MEDICAL cooperation ,COMPLICATIONS of prosthesis ,RESEARCH ,RISK assessment ,TIME ,EVALUATION research ,TREATMENT effectiveness ,RETROSPECTIVE studies ,MEDICAL device removal ,KAPLAN-Meier estimator ,DIAGNOSIS ,EQUIPMENT & supplies - Abstract
Aims: End-stage renal disease (ESRD) increases the risk of implantable cardioverter-defibrillator (ICD) infection. We sought to define outcomes of lead extraction in patients with ESRD.Methods and Results: Implantable cardioverter-defibrillator lead extractions at our institution from January 2006 to March 2014 were stratified by absence (Control-Ex, n = 465) or presence (ESRD-Ex, n = 43) of ESRD. Procedural outcomes and survival were determined by medical records review. Survival in the ESRD-Ex group was compared with a contemporaneous cohort with ESRD undergoing ICD lead implantation (ESRD-I, n = 127). Among extraction patients, those with ESRD were more likely to be extracted for infection (74.4% vs. 28.6%, P < 0.001). Extraction procedure success (Control-Ex: 97% vs. ESRD-Ex: 93%, P = 0.17) and procedural deaths (Control-Ex: 1.1% vs. ESRD-Ex: 2.3%, P = 0.413) were similar. Survival 1 year following extraction was worse in the ESRD-Ex group compared with the Control-Ex, with a survival rate of 65.6% vs. 92.6% (P < 0.001); these curves continued to diverge through year 3. One-year survival in the ESRD-Ex group was worse than among ESRD patients undergoing ICD implant (ESRD-I), but these curves converged and survival was similar by year 3.Conclusions: Implantable cardioverter-defibrillator lead extraction can be performed safely and effectively in patients with ESRD. However, despite high rates of procedural success, long-term mortality following extraction in ESRD patients is substantial. Much of the long-term mortality risk appears to be accounted for by the presence of ESRD and an indication for an ICD. [ABSTRACT FROM AUTHOR]- Published
- 2017
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