LAUSR

BACKGROUND Transvenous lead extraction can have serious adverse events such as cardiac or vascular perforation. Risk factors have not been well characterized. OBJECTIVE To identify factors associated with perforation and death, and characterize lead extraction in a large contemporary population. METHODS We performed a retrospective multi-center 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 modelling. RESULTS 2,325 consecutive patients (61.9 ±16.5 years) underwent extraction of 4,527 leads. Perforation rate was 2.7% (63/2,325) and 30-day mortality was 1.6% with mortality of 0.4% due to perforation (38/2,325; 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=0.002), female sex (OR 3.27, 95% CI 1.91-5.60, p<0.001), left ventricular ejection fraction > 40% (OR 2.81, 95% CI 1.28-6.14, p=0.010), lead age >8 years (OR 2.64, 95% CI 1.52-4.60, p<0.001), ≥ 2 leads extracted (OR 2.49, 95% CI 1.23-5.04, p=0.011), and diabetes (OR 2.12, 95% CI 1.16-3.86, p=0.014). Variables associated with death included infection as indication for extraction (OR 3.85, 95% CI 1.38-10.73, p=0.010), anemia (OR 3.14, 95% CI 1.38-6.61, p=0.003) and patient age (OR 1.04, 95% CI 1.01-1.07, p=0.012). 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.