PhD Scientific Days 2022

Clinical Medicine VI. (Poster discussion will take place on the terrace of the room during the Coffee Break)

Long-term effects of lead removal vs. superfluous lead on survival and device-related complications

Előadó neve

Dr. Schwertner, Walter

Előadó munkahelye

Heart and Vascular Center

Előadó telefonszáma

303058287

Előadó e-mail címe

sch.walterichard@gmail.com

Az előadás címe

Long-term effects of lead removal vs. superfluous lead on survival and device-related complications

Szerző(k) neve és munkahelye

1 Walter Richard Schwertner MD., Heart and Vascular Center, Budapest
2 Boglarka Veres MD., Heart and Vascular Center, Budapest
3 Luca Kuthi MD., Heart and Vascular Center, Budapest
4 Richard Masszi MD., Heart and Vascular Center, Budapest
5 Anett Behon MD,, Heart and Vascular Center, Budapest
6 Eperke Merkel MD., Heart and Vascular Center, Budapest
7 Anita Pinter, Heart and Vascular Center, Budapest
8 Attila Kovács MD. Phd, Heart and Vascular Center, Budapest
9 Endre Zima MD. Phd, Heart and Vascular Center, Budapest
10 Laszlo Geller MD. Phd, Heart and Vascular Center, Budapest
11 Annamria Kosztin MD. Phd, Heart and Vascular Center, Budapest
12 Bela Merkely MD. Phd, Heart and Vascular Center, Budapest

Bemutatás módja

Poszter

Szekció

Clinical Medicine VI. (Poster discussion will take place on the terrace of the room during the Coffee Break)

Language of the presentation

Hungarian

Preferred session

Clinical Medicine

Összefoglaló szövege

Introduction
During Cardiac Resynchronization Therapy (CRT) upgrade procedures, removing the previous right ventricular pacemaker or implantable cardioverter-defibrillator (ICD) lead is still questionable and is performed by the physicians’ discretion. Lead removals (LR) can be associated with a higher fatal periprocedural complication rate, while not extracted superfluous leads (SL) can increase the risk of device-related infections in the long-term.
Aims
To assess the rate of device-related complications and long-term outcomes in CRT patients with LR or SL after a CRT upgrade procedure.
Methods
We created a retrospective dataset involving patients undergoing CRT upgrade procedures. Altogether 143 patients were investigated, 27 (19%) patients had a LR, and 116 (81%) patients had SL. The primary endpoint was all-cause mortality, the secondary endpoint was the composite of pocket infection or decubitus and infective endocarditis.
Results
Patients who underwent LR were younger [67 (64-74) vs 73 (69-78); p=0.016], had shorter dwell time of the previously implanted leads [1.8 (1.4-3.7) vs 6.2 (3.4-9.3); p<0.001], took more loop diuretics [25 (93%) vs 75 (65%); p=0.004] and amiodarone [13 (48%) vs 24 (21%); p=0.006], and were more likely to have prior ICD devices [7 (26%) vs 8 (7%); p=0.009] compared to patients with SL. During the median follow-up time of 2.7 (1.8-4.7) years, 14 (52%) patients reached the primary endpoint from the LR group and 41 (35%) from the SL group. Patients who undergone LR were associated with a higher risk of all-cause mortality (HR: 1.96; 95% CI: 1.01-3.79; p=0.046) compared to the SL group. After adjusting for the relevant covariates, LR did not prove as an independent predictor for all-cause mortality. In contrast, previously implanted ICD devices and the use of diuretics have been proven. No difference was observed between the two patient groups in the secondary endpoint [1 (4%) vs 3 (3%); p=0.575].
Conclusion
Patients in whom lead removal was performed during the CRT upgrade procedure, were younger and less vulnerable compared to those with a superfluous lead. They demonstrated almost a two times lower risk of all-cause mortality, which came from the selection bias for the procedure, as it was not proved as an independent predictor of mortality. We found low and similar complication rates in the two patient groups.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine

Supervisor

Annamaria Kosztin MD. Phd, Merkely Bela MD. Phd

Publication of my abstract

I do not give consent to the publication of my abstract on the website of the congress.

Kind

Szabad

Status

elfogadva

Accepted presentation method

poszter

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4607

Start

10:55

End

11:00

Authors (legacy)

1 Walter Richard Schwertner MD., Heart and Vascular Center, Budapest
2 Boglarka Veres MD., Heart and Vascular Center, Budapest
3 Luca Kuthi MD., Heart and Vascular Center, Budapest
4 Richard Masszi MD., Heart and Vascular Center, Budapest
5 Anett Behon MD,, Heart and Vascular Center, Budapest
6 Eperke Merkel MD., Heart and Vascular Center, Budapest
7 Anita Pinter, Heart and Vascular Center, Budapest
8 Attila Kovács MD. Phd, Heart and Vascular Center, Budapest
9 Endre Zima MD. Phd, Heart and Vascular Center, Budapest
10 Laszlo Geller MD. Phd, Heart and Vascular Center, Budapest
11 Annamria Kosztin MD. Phd, Heart and Vascular Center, Budapest
12 Bela Merkely MD. Phd, Heart and Vascular Center, Budapest