Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry.
Cardiac Tamponade
/ diagnosis
Defibrillators, Implantable
/ adverse effects
Device Removal
/ adverse effects
Equipment Failure
Europe
/ epidemiology
Female
Humans
Incidence
Male
Middle Aged
Outcome and Process Assessment, Health Care
Pacemaker, Artificial
/ adverse effects
Pericardiocentesis
/ methods
Postoperative Complications
/ diagnosis
Prognosis
Registries
/ statistics & numerical data
Risk Factors
Thrombosis
/ diagnosis
Vascular System Injuries
/ diagnosis
Cardiac tamponade
Lead extraction
Major complications
Registry
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
01 May 2019
01 May 2019
Historique:
received:
12
09
2018
accepted:
01
12
2018
pubmed:
28
12
2018
medline:
3
10
2020
entrez:
28
12
2018
Statut:
ppublish
Résumé
We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry. A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths. In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade.
Identifiants
pubmed: 30590520
pii: 5264256
doi: 10.1093/europace/euy300
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
771-780Commentaires et corrections
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.