Follow-up of patients with new cardiovascular implantable electronic devices: Is adherence to the experts’ recommendations associated with improved outcomes?

Photograph used for a story in the Daily Oklahoman newspaper. Caption: "Deadly crash site where 3-year-old Bonnie Whitehouse of Midwest City died under wheels of a skidding truck at Northeast Expressway and Eastern lat Saturday. The loaded truck smashed the rear of the station wagon carrying the Whitehouse family of five. Arrows indicate the point of impact and the spot where the child's body was found. Police said the moving van's brakes apparently failed. the auto was knocked more than 70 feet.

Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads

Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads. Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group. Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years; <0.0001), were less likely to be male (65% versus 68%; =0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years; <0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7-14.4) and 54.3% (95% CI, 52.8-55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62-0.97; =0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years. Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years