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المؤلفون: Thomas Callahan
المصدر: Journal of Cardiovascular Electrophysiology. 33:1041-1044
مصطلحات موضوعية: Pacemaker, Artificial, Treatment Outcome, Physiology (medical), Humans, Cardiology and Cardiovascular Medicine, Device Removal, Defibrillators, Implantable, Retrospective Studies
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المؤلفون: Mohamed Kanj, David M. Nemer, Divyang Patel, Ayman A. Hussein, Khaldoun G. Tarakji, Bruce L. Wilkoff, Anirudh Kumar, Daniel J. Cantillon, Trejeeve Martyn, Bryan Baranowski, Zachary J. Il'Giovine, Randall C. Starling, Thomas Callahan, Niraj Varma, Eoin Donnellan, W.H. Wilson Tang, Laurie Ann Moennich, Kevin Trulock, John Rickard, Oussama M. Wazni
المصدر: Heart. 108:274-278
مصطلحات موضوعية: medicine.medical_specialty, Anthracycline, Population, Cardiomyopathy, Ventricular Function, Left, Cardiac Resynchronization Therapy, Ventricular Dysfunction, Left, Internal medicine, Humans, Medicine, Anthracyclines, cardiovascular diseases, education, Aged, Retrospective Studies, Heart Failure, Retrospective review, education.field_of_study, Ejection fraction, Ventricular Remodeling, business.industry, Cancer, Stroke Volume, Mean age, Middle Aged, medicine.disease, Defibrillators, Implantable, Treatment Outcome, Heart failure, cardiovascular system, Cardiology, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business
الوصف: IntroductionChemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.MethodsWe performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).ResultsA total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (pConclusionsPatients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
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المؤلفون: Bruce D. Lindsay, Niraj Varma, Bruce L. Wilkoff, Walid Saliba, Mina K. Chung, Mandeep Bhargava, Patrick J. Tchou, Khaldoun G. Tarakji, Thomas Callahan, Ryan J. Koene, Mohamed Kanj, Oussama M. Wazni, John Rickard, David O. Martin, Bryan Baranowski, Vivek Menon, Mark Niebauer, Ayman A. Hussein, Daniel J. Cantillon, Thomas Dresing
المصدر: Circulation: Arrhythmia and Electrophysiology. 13
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.medical_treatment, Electric Countershock, Cardiomyopathy, Dofetilide, Ventricular Function, Left, Ventricular Dysfunction, Left, Heart Rate, Recurrence, Physiology (medical), Internal medicine, Atrial Fibrillation, Phenethylamines, medicine, Humans, In patient, Aged, Retrospective Studies, Sulfonamides, Ejection fraction, business.industry, Stroke Volume, Atrial fibrillation, Recovery of Function, Middle Aged, medicine.disease, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, medicine.drug
الوصف: Background: Dofetilide is one of the only anti-arrhythmic agents approved for atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF). However, postapproval data and safety outcomes are limited. In this study, we assessed the incidence and predictors of LVEF improvement, safety, and outcomes in patients with AF with LVEF ≤35% without prior implantable cardioverter defibrillator, cardiac resynchronization therapy, or AF ablation. Methods: An analysis of 168 consecutive patients from 2007 to 2016 was performed. Incidences of adverse events, drug continuation, implantable cardioverter defibrillator and cardiac resynchronization therapy implantation, LVEF improvement (>35%) and recovery (≥50%), AF recurrence, and AF ablation were determined. Multivariable regression analysis to identify predictors of LVEF improvement/recovery was performed. Results: The mean age was 64±12 years. Dofetilide was discontinued before hospital discharge in 46 (27%) because of QT prolongation (14%), torsades de pointe or polymorphic ventricular tachycardia/fibrillation (6% [sustained 3%, nonsustained 3%]), ineffectiveness (5%), or other causes (3%). At 1 year, 43% remained on dofetilide. Freedom from AF was 42% at 1 year, and 40% underwent future AF ablation. LVEF recovered (≥50%) in 45% and improved to >35% in 73%. Predictors of LVEF improvement included presence of AF during echocardiogram (odds ratio, 4.22 [95% CI, 1.71–10.4], P =0.002), coronary artery disease (odds ratio, 0.35 [95% CI, 0.16–0.79], P =0.01), left atrial diameter (odds ratio, 0.52 per 1 cm increase [95% CI, 0.30–0.90], P =0.01), and LVEF (odds ratio, per 1% increase, 1.09 [95% CI, 1.02–1.16], P =0.006). The C statistic was 0.78. Conclusions: In patients with LVEF ≤35%, who are potential implantable cardioverter defibrillator candidates, treated with dofetilide as an initial anti-arrhythmic strategy for AF, drug discontinuation rates were high, and many underwent future AF ablation. However, most patients had improvement in LVEF, obviating the need for primary prevention implantable cardioverter defibrillator.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9b4c1657674b6e366ceaf5bf5a65792
https://doi.org/10.1161/circep.119.008168 -
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المؤلفون: Ayman A. Hussein, Thomas Dresing, Niraj Varma, Walid Saliba, Jad A. Ballout, Bruce D. Lindsay, Mohamed Diab, David O. Martin, Mohamed Kanj, Patrick J. Tchou, Oussama M. Wazni, John Rickard, Mark Niebauer, Mandeep Bhargava, Bryan Baranowski, Mina K. Chung, Khaldoun G. Tarakji, Thomas Callahan, Daniel J. Cantillon
المصدر: Circ Arrhythm Electrophysiol
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Radiofrequency ablation, medicine.medical_treatment, Drug Resistance, Shock, Cardiogenic, Catheter ablation, Ventricular tachycardia, Article, Ventricular Function, Left, law.invention, Extracorporeal Membrane Oxygenation, Refractory, Heart Rate, Recurrence, Risk Factors, law, Physiology (medical), Internal medicine, medicine, Humans, Assisted Circulation, Hospital Mortality, Registries, Aged, Retrospective Studies, business.industry, Cardiogenic shock, Stroke Volume, Recovery of Function, Middle Aged, Ablation, medicine.disease, Treatment Outcome, Concomitant, Heart failure, Ventricular Fibrillation, Catheter Ablation, Tachycardia, Ventricular, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
الوصف: Background: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. Methods: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010–2017). Results: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction–induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. Conclusions: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f22fb2268fcc13288857f3c52106224c
https://doi.org/10.1161/circep.119.007669 -
5Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction
المؤلفون: Michael Brunner, Thomas Callahan, Walid Saliba, Mingyuan Shao, Ayman A. Hussein, Yoaav Krauthammer, Khaldoun G. Tarakji, Jack Rickard, David O. Martin, Danny Markabawi, Carmela D. Tan, Daniel J. Cantillon, E. Rene Rodriguez, Oussama M. Wazni, Bryan Baranowski, Mohamed Kanj, Mark Niebauer, Bruce L. Wilkoff
المصدر: Heart Rhythm. 15:318-325
مصطلحات موضوعية: Male, Pacemaker, Artificial, medicine.medical_specialty, medicine.medical_treatment, H&E stain, 030204 cardiovascular system & hematology, Veins, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), medicine, Humans, 030212 general & internal medicine, Major complication, Vein, Lead (electronics), Device Removal, Ohio, Retrospective Studies, business.industry, Incidence, Arrhythmias, Cardiac, Middle Aged, Vascular System Injuries, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Surgery, Transvenous lead, Treatment Outcome, medicine.anatomical_structure, Equipment Failure, Female, Cardiology and Cardiovascular Medicine, Complication, business, Follow-Up Studies, Lead extraction
الوصف: Background The major complication rate of transvenous lead extraction (TLE) is estimated to be 1%–2%. Laceration of the central veins can be fatal. Objectives To define the incidence and extent of venous injuries on a microscopic level after TLE and compare these data with those of clinically documented events of venous laceration. Methods We studied all patients who underwent TLE at our tertiary center within 30 months via a variety of techniques. Extracted leads and tissue around them were fixed in formalin. Pathologic examination was standardized to examine the leads identifying the areas covered by tissue cuffs along the length of the lead. The cuffs were removed and sectioned transversely to their longitudinal axis. Microscopic examination was performed using hematoxylin and eosin stains and Movat stains to identify the presence of vein tissue. Results In all, 861 leads (585 pacemaker and 272 defibrillator leads) were extracted from 461 patients (median age 63 years, standard deviation 15 years), with an average of 1.9 leads per patient and a median lead age of 2546 days. On microscopic review, 80 leads (9.3%) in 72 of 461 patients (15.6%) showed segments of vein, most of which were transmural (venous tissue including adventitia). Despite this finding, only 5 catastrophic complications (1.1%) occurred that required emergent surgical intervention. Risk factors for venous injury included implantable cardioverter defibrillator lead, age of lead, and the use of laser sheath. Conclusions Microscopic venous injuries during lead extraction are common but often not recognized clinically.
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المؤلفون: Mina K. Chung, Thomas Callahan, Mohamed Bassiouny, Daniel J. Cantillon, Shailee Shah, Mandeep Bhargava, Thomas Dresing, Walid Saliba, Ayman A. Hussein, Amr F. Barakat, Bruce D. Lindsay, Mohamed Kanj, Bryan Baranowski, Karim Abdur Rehman, Oussama M. Wazni, Patrick J. Tchou, John Rickard, Khaldoun G. Tarakji
المصدر: Circulation. Arrhythmia and electrophysiology. 11(4)
مصطلحات موضوعية: Reoperation, medicine.medical_specialty, Cavotricuspid isthmus, Time Factors, medicine.medical_treatment, Recurrent atrial fibrillation, Action Potentials, Catheter ablation, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Superior vena cava, Heart Rate, Predictive Value of Tests, Recurrence, Physiology (medical), Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, Registries, Retrospective Studies, business.industry, Atrial fibrillation, medicine.disease, Ablation, Surgery, Electrophysiology, Treatment Outcome, Pulmonary Veins, cardiovascular system, Catheter Ablation, Cardiology and Cardiovascular Medicine, business, Atrial substrate, Electrophysiologic Techniques, Cardiac
الوصف: Background: Atrial fibrillation recurrence after initial long-term success of catheter ablation has been described, yet not well studied. We assessed the electrophysiological findings and outcomes of repeat ablation procedures in this setting. Methods and Results: Between 2000 and 2015, 10 378 patients underwent atrial fibrillation ablation and were enrolled in a prospectively maintained data registry. From this registry, we included all 137 consecutive patients who had initial long-term success, defined as freedom from recurrent arrhythmia for >36 months off antiarrhythmics, then underwent repeat ablation for recurrent atrial fibrillation. The median arrhythmia-free period that defined long-term success was 52 months (41–68 months). In redo ablations, reconnection along at least one of the pulmonary veins (PVs) was found in 111 (81%) patients. Reconnection along a left superior, left inferior, right superior, and right inferior PV was found in 64%, 62%, 50%, and 54% of patients, respectively, and were reisolated. Additional non-PV ablations were performed in 127 (92.7%) patients: posterior wall (46%), septal to right PVs (49%), superior vena cava (35%), roof lines (52%), and cavotricuspid isthmus (33%). After a median follow-up of 17 months (5–36.9 months), 103 patients (75%) were arrhythmia free (79 off antiarrhythmics, 24 on antiarrhythmics). Conclusions: PV reconnection is the most common electrophysiological finding in patients with atrial fibrillation recurrence after long-term success, but with lower rates than what had been reported for early recurrences. In our experience, repeat ablations in this setting involve complex ablation approaches to reisolate the PVs and modify the atrial substrate and are associated with good success rates.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6eb32f4e3095f65b25b3deedccf5c200
https://pubmed.ncbi.nlm.nih.gov/29654136 -
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المؤلفون: Oussama M. Wazni, David O. Martin, P. Peter Borek, Khaldoun G. Tarakji, Daniel J. Cantillon, Edmond M. Cronin, Jessen Jacob, Michael Brunner, Thomas Callahan, Valeria E. Duarte, Walid Saliba, Bryan Baranowski, Mohamed Kanj, Mark Niebauer, Bruce L. Wilkoff
المصدر: Heart Rhythm. 10:1444-1450
مصطلحات موضوعية: Male, Medical Device Recalls, Cardiac Catheterization, medicine.medical_specialty, medicine.medical_treatment, Icd lead, Comparative safety, Clinical success, Tachycardia, Physiology (medical), Internal medicine, medicine, Humans, Major complication, Lead (electronics), Device Removal, Aged, Retrospective Studies, business.industry, Patient Selection, Equipment Design, Middle Aged, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Transvenous lead, Treatment Outcome, Sprint, Cardiology, Equipment Failure, Female, Cardiology and Cardiovascular Medicine, business
الوصف: Background Comparative safety and efficacy associated with transvenous lead extraction (TLE) of recalled and non-recalled implantable cardioverter-defibrillator (ICD) leads has not been well characterized. Objectives To compare the indications, techniques, and procedural outcomes of recalled vs non-recalled ICD lead extraction procedures. Methods TLE procedures performed at our institution from June 2002 to June 2012 in which Riata, Sprint Fidelis, or non-recalled ICD leads were extracted were included in the analysis. Results ICD lead extraction procedures were performed in 1079 patients, including 430 patients with recalled leads (121 Riata, 308 Sprint Fidelis, and 1 Riata and Sprint Fidelis) and 649 patients with non-recalled ICD leads. A total of 2056 chronic endovascular leads were extracted, of which 1215 (59.1%) were ICD leads. Overall, there was 96.8% complete procedural success, 99.1% clinical success, and 0.9% failure, with 3.9% minor complications and 1.5% major complications. Procedural outcomes for Riata and Sprint Fidelis TLE procedures were no different. Lead implant duration was significantly less in recalled than in non-recalled ICD lead TLE procedures. Complete procedural success was higher in recalled (424 of 430 [98.6%]) than in non-recalled (621 of 649 [95.7%]; P = .007) ICD lead TLE procedures. Minor complications were lower in recalled (10 of 430 [2.3%]) than in non-recalled (32 of 649 [5.0%]; P = .030) ICD lead TLE procedures. Rates of clinical success, failure, and major complications were no different in the recalled and non-recalled ICD lead TLE procedures. Conclusion In our experience, recalled ICD leads were extracted with safety and efficacy comparable to that of non-recalled ICD leads.
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المؤلفون: Mohamed Kanj, Patrick J. Tchou, Ayman A. Hussein, Walid Saliba, Bruce D. Lindsay, Oussama M. Wazni, George Thomas, Serge C. Harb, Valeria E. Duarte, Bryan Baranowski, Georges N. Nakhoul, Mandeep Bhargava, Thomas Callahan, Thomas Dresing, Andrea Natale
المصدر: Journal of Interventional Cardiac Electrophysiology. 37:41-46
مصطلحات موضوعية: Male, Cardiac Catheterization, medicine.medical_treatment, Risk Assessment, Reperfusion therapy, Physiology (medical), medicine, Humans, Survival rate, Stroke, Survival analysis, Aged, Ohio, Retrospective Studies, Cardiac catheterization, business.industry, Incidence, Incidence (epidemiology), Retrospective cohort study, Middle Aged, medicine.disease, Survival Analysis, Survival Rate, Catheter, Treatment Outcome, Anesthesia, Female, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, business
الوصف: We sought to identify the characteristics, treatment, and outcomes of periprocedural cerebrovascular accident (PCVA) during electrophysiologic (EP) procedures. Periprocedural cerebrovascular accident is one of the most feared complications during EP procedures with very few data regarding its characteristics, management, and outcomes. Between January 1998 and December 2008, we reviewed 30,032 invasive EP procedures for PCVA occurrence and characteristics. Management and outcomes were also determined. Thirty-eight CVAs were identified. Twenty (53 %) were intraprocedural and 18 (47 %) postprocedural. Thirty-two (84 %) were classified as strokes and six (16 %) as transient ischemic attacks. All CVAs except one (37, 97 %) were ischemic and the vast majority occurred during ablation procedures (36, 95 %). Among the 31 patients with ischemic stroke, 11 (35 %) were treated with reperfusion (eight catheter-based therapy and three intravenous t-PA) of whom five (46 %) had complete recovery, three (27 %) had partial recovery, and three (27 %) had no recovery. No hemorrhagic transformations occurred. Periprocedural cerebrovascular accident during EP procedures is rare and is almost always ischemic. It occurs more frequently during ablation procedures. Reperfusion therapy is feasible and safe.
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المؤلفون: Mina K. Chung, Khaldoun G. Tarakji, Ali H. Hakim, Mohamed Kanj, Amr F. Barakat, Mark Niebauer, Mohammed A. Chamsi-Pasha, Bruce D. Lindsay, Oussama M. Wazni, Andrea Natale, David O. Martin, Ayman A. Hussein, Thomas Dresing, Mandeep Bhargava, Thomas Callahan, Patrick J. Tchou, Mohammed Bassiouny, Daniel J. Cantillon, Rasha Al-Bawardy, Bryan Baranowski, Niraj Varma, Walid Saliba
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Radiofrequency ablation, medicine.drug_class, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, Article, law.invention, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, law, Heart Conduction System, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, Natriuretic peptide, Medicine, Humans, 030212 general & internal medicine, Heart Atria, Ultrasonography, Interventional, Retrospective Studies, medicine.diagnostic_test, business.industry, Hazard ratio, Atrial fibrillation, Atrial Remodeling, Middle Aged, medicine.disease, Ablation, Confidence interval, Treatment Outcome, Cardiology, Catheter Ablation, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Follow-Up Studies
الوصف: Background— Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation–related atrial remodeling. Methods and Results— Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005–2012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th–75th percentiles 1–6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels ( P =0.01), C-reactive protein levels ( P P =0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively ( P categorical P P categorical Conclusions— In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f008ecceb452de84b20c13ec7fe6591a
https://europepmc.org/articles/PMC5349298/ -
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المؤلفون: Daniel J. Cantillon, Edmond M. Cronin, Khaldoun G. Tarakji, Oussama M. Wazni, Bryan Baranowski, Valeria E. Duarte, Michael Brunner, Thomas Callahan, Walid Saliba, Bruce L. Wilkoff, Mohamed Kanj, Mark Niebauer, David O. Martin, Changhong Yu
المصدر: Heart rhythm. 11(5)
مصطلحات موضوعية: Male, medicine.medical_specialty, Pacemaker, Artificial, Heart Diseases, medicine.medical_treatment, Logistic regression, Postoperative Complications, Risk Factors, Physiology (medical), medicine, Humans, Survival rate, Device Removal, Aged, Ohio, Retrospective Studies, Ejection fraction, business.industry, Incidence (epidemiology), Incidence, Endovascular Procedures, Retrospective cohort study, Middle Aged, Implantable cardioverter-defibrillator, Surgery, Defibrillators, Implantable, Survival Rate, Treatment Outcome, Equipment Failure, Female, Implant, Cardiology and Cardiovascular Medicine, business, Body mass index, Follow-Up Studies
الوصف: It is difficult to predict adverse patient outcomes associated with transvenous lead extraction (TLE) procedures.The purpose of this study was to examine the safety and efficacy of chronic endovascular pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction and risk factors associated with adverse patient outcomes.Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. Univariate and multivariable logistic regression analyses were performed to evaluate for associations with outcomes. Continuous data are given as median (25th, 75th percentile). Categorical data are given as number (percentage).In total, 5521 leads (4137 [74.9%] pacemaker, 1384 [25.1%] ICD) were extracted during 2999 TLE procedures (patient age 67.2 [55.2, 76.2] years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years, and 2.0 (1.0, 2.0) leads were extracted per procedure. Powered sheaths were used in 74.9% of procedures. Overall, there was 95.1% complete procedural success, 98.9% clinical success, and 1.1% failure, with 3.6% minor complications and 1.8% major complications. All-cause mortality within 30 days of TLE was 2.2%. Multivariable predictors of major complications included cerebrovascular disease, ejection fraction ≤15%, lower platelet count, international normalized ratio ≥1.2, mechanical sheaths, and powered sheaths. Multivariable predictors of all-cause mortality within 30 days of TLE included body mass index25 kg/m(2), end-stage renal disease, higher New York Heart Association functional class, lower hemoglobin, higher international normalized ratio, lead extraction for infection, and extraction of a dual-coil ICD lead.TLE in this single-center experience was highly successful. Risk factors associated with adverse patient outcomes were identified.
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