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Original article
DOI: 10.1016/j.rec.2020.08.013
Available online 28 October 2020
Safety of transvenous lead removal in adult congenital heart disease: a national perspective
Seguridad de la extracción transvenosa de electrodos en las cardiopatías congénitas del adulto: una perspectiva nacional
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Xiaofan Guoa,b,
Corresponding author
guoxiaofan1986@hotmail.com

Corresponding author: Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
, Robert M. Haywardc, Eric Vittinghoffb, Sun Yong Leec, Ian S. Harrisc,d, Mark J. Pletcherb, Byron K. Leec
a Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, China
b Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
c Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States
d Cardiovascular Research Institute, University of California, San Francisco, California, United States
Received 13 February 2020. Accepted 12 August 2020
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Tables (3)
Table 1. Demographic, clinical, and hospital characteristics of adult patients with and without congenital heart disease undergoing transvenous lead removal in the United States from 2005 to 2014
Table 2. Complication and mortality rates of transvenous lead removal in patients with and without congenital heart disease
Table 3. In-hospital mortality and complications related to transvenous lead removal in patients with congenital heart disease vs those without after propensity score matching
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Additional material (1)
Abstract
Introduction and objectives

Data are scarce on outcomes of transvenous lead removal (TLR) in adult congenital heart disease (CHD). We evaluated the safety of the TLR procedure in adult CHD patients from a 10-year national database.

Methods

We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify TLR procedures in adult patients with and without CHD from 2005 to 2014. Outcomes included in-hospital mortality and complications.

Results

Of 132 068 adult patients undergoing TLR, 1939 had simple CHD, 657 had complex CHD, and 626 had unclassified CHD. The number of TLR procedures in adult CHD slightly increased from 236 in 2005 to 445 in 2014, with fluctuations over the study period. The overall rate of any complications in the TLR procedure was 16.6% in patients with CHD vs 10.1% in patients without CHD (P <.001). In a propensity score-matched cohort, CHD was associated with a higher risk of any complication after full adjustment vs patients without CHD (adjusted odd ratio, 1.49; 95% confidence interval, 1.11-1.99; P=.007). Simple and complex CHD were associated with 1.5- and 2.1-fold increased risks of any TLR-related complication, respectively. CHD was not associated with an increased risk of in-hospital mortality (adjusted odd ratio, 0.77; 95% confidence interval, 0.42-1.39; P=.386).

Conclusions

Compared with patients without CHD, adult patients with simple and complex CHD undergoing TLR are more likely to have complications but show no increase in mortality.

Keywords:
Transvenous lead removal
Congenital heart disease
Complication
Mortality
Abbreviations:
CHD
HCUP-NIS
ICD
TLR
Resumen
Introducción y objetivos

Hay poca información sobre los resultados de la extracción transvenosa de electrodos (ETE) en adultos con cardiopatías congénitas (CC). Nuestro objetivo fue evaluar la seguridad del procedimiento de la ETE en pacientes con CC a partir del análisis de bases de datos nacionales de series de pacientes durante 10 años.

Métodos

Se analizaron las bases de datos Healthcare Cost y Utilization Project Nationwide Inpatient Sample para identificar los procedimientos de la ETE en pacientes adultos con y sin CC entre los años 2005 y 2014, centrándose en los números sobre mortalidad hospitalaria y complicaciones.

Resultados

Se encontró que 132.068 pacientes adultos se sometieron a ETE, 1.939 con CC simple, 657 con CC compleja y 626 con CC no especificada. El número de procedimientos de ETE en adultos con CC aumentó ligeramente de 236 casos en 2005 a 445 casos en 2014, con fluctuaciones durante el periodo de estudio. La tasa general de cualquier complicación en el procedimiento de ETE fue del 16,6% en el grupo de CC frente al 10,1% en el de pacientes sin CC (p <0,001). En una cohorte emparejada por puntuación de propensión, la CC se asoció con un mayor riesgo de cualquier complicación después del ajuste completo en comparación con los pacientes sin CC (ORa=1,49; IC95%, 1,11-1,99; p=0,007). Las CC simples y complejas se asociaron respectivamente con un riesgo 1,5 y 2,1 veces mayor de cualquier complicación relacionada con la ETE. La CC no se asoció con un mayor riesgo de mortalidad hospitalaria (ORa=0,77; IC95%, 0,42-1,39; p=0,386).

Conclusiones

Los pacientes adultos con CC simples y complejas sometidos a ETE fueron más propensos a sufrir complicaciones, sin que ello supusiera un aumento de la mortalidad en comparación con los pacientes sin CC.

Palabras clave:
Extracción transvenosa de electrodos
Cardiopatía congénita
Complicación
Mortalidad

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