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Gianni C, Elchouemi M, Helmy R, Spinetta L, La Fazia VM, Pierucci N, Asfour I, Della Rocca DG, Mohanty S, Bassiouny MA, Coffeen PC, Hranitzky PM, Neely RC, Natale A, Canby RC, Al-Ahmad A. Safety and feasibility of same-day discharge following uncomplicated transvenous lead extraction. J Cardiovasc Electrophysiol 2024; 35:278-287. [PMID: 38073051 DOI: 10.1111/jce.16147] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Transvenous lead extraction (TLE), while mostly a safe procedure, has risk of serious periprocedural complications. As such, overnight hospitalization remains a routine practice. In our center, we routinely discharge patients on the same day following an uncomplicated TLE. METHODS This is a retrospective study of 265 consecutive patients who underwent uncomplicated TLE in our center between 2019 and 2021. Same-day discharge (SDD) patients are compared with those who stayed at least overnight for observation after the TLE procedure (non-SDD group). To assess the safety of an SDD strategy after uncomplicated TLE, the main study endpoint was to compare the rate of major procedure-related complications at 1-, 7-, and 30-days. To identify the factors influencing the operator's decision to discharge the patient on the same day, the secondary endpoint was to analyze clinical and procedural predictors of SDD. RESULTS A total of 153 patients were discharged the same day after uncomplicated TLE (SDD), while 112 stayed at least overnight after the procedure (non-SDD). There was no significant difference in major procedure-related complications at 1-day (SDD 0% vs. non-SDD 1.8%, p value = ns), while patients in the SDD group had a lower rate of 7- and 30-day complications when compared with those in the non-SDD group (2.1% vs. 8.2%, p value = .0308; and 3.5% vs. 16%, p value = .0049, respectively). Noninfectious indication for TLE (OR 16.1, 95% confidence interval [CI] 4.29-77.6) and procedure end time before 12:00 (OR 2.82, 95% CI 1.11-7.27) were the only independent predictors of SDD. CONCLUSION SDD discharge following uncomplicated TLE in selected patients (i.e., those without device infection and when the TLE procedure is completed in the morning) is feasible and safe.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohanad Elchouemi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rami Helmy
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Lauryn Spinetta
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Cardiothoracic and Vascular Surgeons, Austin, Texas, USA
| | | | - Nicola Pierucci
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- Department of Clinical Internal Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Issa Asfour
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Paul C Coffeen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Robert C Neely
- Cardiothoracic and Vascular Surgeons, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- HCA National Medical Director of Cardiac Electrophysiology, Nashville, Tennessee, USA
- Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Ohio, Cleveland, USA
| | - Robert C Canby
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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El-Chami MF. Same day discharge after transvenous lead extraction: Balancing safety and efficiency. J Cardiovasc Electrophysiol 2024; 35:288-289. [PMID: 38105428 DOI: 10.1111/jce.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Dagher L, Tfaily MA, Vavuranakis M, Bhatia NK, Westerman SB, Shah AD, Lloyd MS, Leal M, De Lurgio DB, Merchant A, Panagopoulos A, Patel AM, Tompkins C, Leon AR, Merchant FM, El-Chami MF. Safety of same-day discharge after lead extraction procedures. Heart Rhythm 2023; 20:1669-1673. [PMID: 37591366 DOI: 10.1016/j.hrthm.2023.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after cardiovascular procedures is rapidly gaining ground. OBJECTIVE We sought to evaluate the safety of SDD after transvenous lead extraction (TLE). METHODS We performed a retrospective chart review of patients who underwent elective TLE between January 2020 and October 2021 at our institution. The primary outcome was SDD, and major procedural complications and readmissions within 30 days of the procedure were secondary outcomes. RESULTS In this analysis of 111 patients who underwent elective TLE, 80 patients (72%) were discharged on the same day (SDD group) while 31 patients (28%) stayed overnight (overnight group). Lead malfunction was the most common indication for TLE in both groups. Patients in the overnight group were more likely to have a lead dwell time of ≤10 years than those in the SDD group (38.7% vs 20% of all leads in each group; P = .042), have laser sheaths used for extraction and a higher number of leads extracted. No major complications were reported in both groups. In a multivariate analysis, lower body mass index and the use of laser sheath during TLE were predictors of overnight stay. Patients who underwent a procedure using advanced extraction techniques were 3.5 times more likely to stay overnight (95% confidence interval 1.27-9.78; P = .016). CONCLUSION In appropriately selected patients undergoing elective lead extraction, SDD is feasible and safe. Higher body mass index, fewer extracted leads, shorter lead dwell times (<10 years), and less frequent use of laser-powered extraction sheaths were associated with an increased likelihood of SDD.
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Affiliation(s)
- Lilas Dagher
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamad Ali Tfaily
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Vavuranakis
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Neal Kumar Bhatia
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy B Westerman
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand D Shah
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Miguel Leal
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - David B De Lurgio
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Alam Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anastasios Panagopoulos
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anshul M Patel
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Tompkins
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
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Boriani G, Imberti JF, Leyva F, Casado-Arroyo R, Chun J, Braunschweig F, Zylla MM, Duncker D, Farkowski MM, Pürerfellner H, Merino JL. Length of hospital stay for elective electrophysiological procedures: a survey from the European Heart Rhythm Association. Europace 2023; 25:euad297. [PMID: 37789664 PMCID: PMC10563655 DOI: 10.1093/europace/euad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023] Open
Abstract
AIMS Electrophysiological (EP) operations that have traditionally involved long hospital lengths of stay (LOS) are now being undertaken as day case procedures. The coronavirus disease-19 pandemic served as an impetus for many centres to shorten LOS for EP procedures. This survey explores LOS for elective EP procedures in the modern era. METHODS AND RESULTS An online survey consisting of 27 multiple-choice questions was completed by 245 respondents from 35 countries. With respect to de novo cardiac implantable electronic device (CIED) implantations, day case procedures were reported for 79.5% of implantable loop recorders, 13.3% of pacemakers (PMs), 10.4% of implantable cardioverter defibrillators (ICDs), and 10.2% of cardiac resynchronization therapy (CRT) devices. With respect to CIED generator replacements, day case procedures were reported for 61.7% of PMs, 49.2% of ICDs, and 48.2% of CRT devices. With regard to ablations, day case procedures were reported for 5.7% of atrial fibrillation (AF) ablations, 10.7% of left-sided ablations, and 17.5% of right-sided ablations. A LOS ≥ 2 days for CIED implantation was reported for 47.7% of PM, 54.5% of ICDs, and 56.9% of CRT devices and for 54.5% of AF ablations, 42.2% of right-sided ablations, and 46.1% of left-sided ablations. Reimbursement (43-56%) and bed availability (20-47%) were reported to have no consistent impact on the organization of elective procedures. CONCLUSION There is a wide variation in the LOS for elective EP procedures. The LOS for some procedures appears disproportionate to their complexity. Neither reimbursement nor bed availability consistently influenced LOS.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association)
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francisco Leyva
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association)
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Ruben Casado-Arroyo
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association)
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Julian Chun
- Medizinische Klinik III, CCB am Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Frieder Braunschweig
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association)
- Department of Medicine; Solna, Karolinska Institutet and ME Cardiology, Karolinska University Hospital, Norrbacka S1:02, Eugeniavagen 27, Stockholm 171 77, Sweden
| | - Maura M Zylla
- mHealth and Health Economics and PROM Committee of EHRA (European Heart Rhythm Association)
- Department of Cardiology, Medical University Hospital, Heidelberg, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover 30625, Germany
| | - Michał M Farkowski
- Department of Cardiology, Ministry of Interior and Administration National Medical Institute, Warsaw, Poland
| | - Helmut Pürerfellner
- Ordensklinikum Linz Elisabethinen, Interne II/Kardiologie und Interne Intensivmedizin, Fadingerstraße 1, 4020 Linz, Austria
| | - José L Merino
- Arrhythmia-Robotic Electrophysiology Unit, La Paz University Hospital, IdiPAZ, Universidad Autonoma, Madrid, Spain
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Khurana S, Das S, Frishman WH, Aronow WS, Frenkel D. Lead Extraction-Indications, Procedure, and Future Directions. Cardiol Rev 2023:00045415-990000000-00152. [PMID: 37729602 DOI: 10.1097/crd.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Cardiac implantable electronic device (CIED) implantation has steadily increased in the United States owing to increased life expectancy, better access to health care, and the adoption of updated guidelines. Transvenous lead extraction (TLE) is an invasive technique for the removal of CIED devices, and the most common indications include device infections, lead failures, and venous occlusion. Although in-hospital and procedure-related deaths for patients undergoing TLE are low, the long-term mortality remains high with 10-year survival reported close to 50% after TLE. This is likely demonstrative of the increased burden of comorbidities with aging. There are guidelines provided by various professional societies, including the Heart Rhythm Society, regarding indications for lead extraction and management of these patients. In this paper, we will review the indications for CIED extraction, procedural considerations, and management of these patients based upon the latest guidelines.
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Affiliation(s)
- Sumit Khurana
- From the Department of Internal medicine, MedStar Union Memorial hospital, Baltimore, MD
| | - Subrat Das
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, NY
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Daniel Frenkel
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY
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