Safety and efficacy of cardiovascular implantable electronic device extraction in elderly patients: A meta-analysis and systematic review

• Main Authors: Andrew Y. Lin, MD, Florentino Lupercio, MD, Gordon Ho, MD, FHRS, Travis Pollema, DO, Victor Pretorius, MBchB, Ulrika Birgersdotter-Green, MD, FHRS
• Format: Article
• Language: English
• Published: Elsevier 2020-10-01
• Series: Heart Rhythm O2
• Subjects: Cardiovascular implantable electronic device; Implantable cardioverter-defibrillator; Octogenarian; Pacemaker; Transvenous lead extraction
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666501820301094

Background: Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective: To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods: We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results: Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 – 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 – 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 – 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 – 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 – 2.29, p = 0.13). Conclusion: In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.