Impact of generator replacement and other device procedures on timing of implantable cardioverter-defibrillator lead removal

There is a suggestion that implantable cardioverter-defibrillator (ICD) lead failure is related to generator replacement. The aim of the study was to investigate the impact of ICD lead implantation and subsequent procedures on the risk of infection and lead performance. Data from 1068 transvenous lead extraction (TLE) procedures with ICD lead removal were analyzed. It was shown that the most common cause of ICD lead removal was infection (36%), mechanical lead damage and dysfunction of undamaged leads (34% and 21%). The most common procedures preceding TLE were primary implantation (56%) and generator replacement (27%). Older age of the lead increased the probability of lead extraction due to mechanical damage [HR = 1.107; 95%CI (1.083–1.113), p < 0.001], other procedures were more likely to result in increased risk of infection [HR = 2.517; 95%CI (1.815–3.492), p < 0.001]. In lead age-matched groups the probability of lead extraction due to mechanical damage increased after reimplantation [HR = 1.614;95%CI (1.306–1.994), p < 0.001] and because of the infection it was even higher after reimplantation [HR = 1.500;95%CI (1.184–1.899), p < 0.001] and upgrading/revision procedures [HR = 2.372;95%CI (1.783–3.154), p < 0.001]. There is a link between the age of an ICD lead and the probability of its mechanical damage. Generator replacement is associated both with early mechanical lead damage and infections, with their risk additionally increased by such procedures as system upgrading/revision.