Abstract 4139400: Transvenous Lead Extraction Outcomes in Hemodialysis Patients: Assessing the Risk of Infection

Introduction: CIED implant volume remains high, leading to an increase in TLE (Transvenous Lead Extraction) procedures to manage a growing population with aging leads. However, data on TLE outcomes for dialysis patients is limited. Aims: To determine if dialysis patients in the current era have worse outcomes after TLE (procedural success rate, major complications, and 30-day all-cause mortality (ACM)); and to find predictors for the same. Methods: We included all TLE procedures at our institution between 2013-2022 (n=1614; dialysis=53; non-dialysis=1561). Data was collected retrospectively from electronic medical records. Outcomes were first analyzed for all patients; followed by subgroup analyses for dialysis patients with infection, since that was the most common indication for TLE (48/53; 90.6%). Within the subgroup, we looked at intracardiac mass on echo, positive blood culture, and pocket infection as predictors. Results: Mean age of our sample was 62.3 years and 66.8% were male. Lead age and combined lead age were significantly different between dialysis and non-dialysis patients (8.8 vs 5.6 years; p<0.001, and 11.1 vs 16.5 years; p=0.02). Success rate and major complications rate was similar (96.2% vs 95.5%; p=0.8, and 3.8% vs 2.1%; p=0.4), but 30-day ACM rates were significantly worse among dialysis patients (13.2% vs 2%; p<0.001). Multivariate analysis found dialysis, lead extraction due to infection, and NYHA Class 3 or 4 to be independent predictors of 30-day ACM among the entire study population (Table 1). Within the subgroup, only intracardiac mass was associated with significantly worse 30-day ACM (33.1% vs 6.1%; p=0.01), which was confirmed with multivariate analysis [OR=22.4 (1.8-280.4); p=0.02] (Table 2). Conclusion: Dialysis is an independent predictor of 30-day ACM after TLE, along with lead extraction due to infection, and NYHA Class 3 or 4. Within the subgroup of dialysis patients with infection, visualization of intracardiac mass on echo is a predictor of 30-day ACM.