From the Guidelines
The mortality rate associated with pacemaker lead extraction is approximately 0.0%-1.0%, with most studies reporting rates of less than 1%. This low mortality rate is consistent across multiple studies, with procedural success rates consistently reported to be very high, with most studies reporting rates of >95% 1. The mortality rate for pacemaker lead extraction is significantly lower compared to treatment with antibiotics only, with a 1-year mortality rate of 13.3% for patients who underwent extraction compared to 38.1% for those who did not 1.
Key Factors Influencing Mortality Rate
- The timing of CIED extraction, with early extraction associated with lower 1-year mortality rates 1
- The experience of the surgical team and the facility's ability to handle potential complications
- The patient's overall health, with those having multiple comorbidities facing a higher risk
Minimizing Risks
- Pacemaker extractions should only be performed by experienced electrophysiologists in facilities equipped to handle potential complications
- Patients should be closely monitored during and after the procedure, with immediate access to cardiac surgery if needed
- Careful patient selection and thorough pre-procedural planning are essential to minimize risks
Clinical Outcomes
- Procedural complication rates are consistently low, ranging from 0.0%-4.0% 1
- Reinfection rates are significantly lower when complete extraction occurs, with rates ranging from 1.0%-5.3% compared to 20.8%-50.0% for incomplete extraction 1
From the Research
Mortality Rate Associated with Pacemaker Lead Extraction
- The mortality rate associated with pacemaker lead extraction can be estimated from various studies:
- A study published in 2014 2 reported an all-cause mortality within 30 days of transvenous lead extraction (TLE) of 2.2%.
- Another study published in 2024 3 reported an in-hospital mortality rate of 6% among patients undergoing cardiac implantable electronic device extraction, including pacemaker lead extraction.
- A study published in 2010 4 reported 57 deaths associated with device-assisted lead extraction between 1995 and 2008, highlighting the potential risks of the procedure.
- Predictors of mortality after pacemaker lead extraction or implantation have been identified in several studies:
- A study published in 2024 5 found that older age, being female, having dual-chamber pacemaker, higher Charlson comorbidity index, presence of complications, and New York Heart Association class III or IV were associated with mortality.
- A study published in 2016 6 found that pre-existing chronic kidney disease and history of smoking were independent risk factors for early mortality after temporary-permanent pacemaker placement.
- Overall, the mortality rate associated with pacemaker lead extraction varies depending on the study and population, but it is generally considered a high-risk procedure that requires careful consideration and skilled management.