Arrhythmias & electrophysiology
Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction
Authors' conclusion
In a large nationwide sample, the incidence of LRVO was substantial, affecting 1 of every 20 patients with CIEDs. Device extraction was the most common intervention and was associated with long-term reduction in recurrent health care utilization.
Study context
- Population
- Medicare beneficiaries after cardiovascular implantable electronic device (CIED) implant, October 1, 2015 to December 31, 202028,214 developed lead-related venous obstruction (LRVO)
- Participants
- 649,524 beneficiaries
- Outcome
- Symptomatic lead-related venous obstruction (LRVO), cumulative incidence
- Follow-up
- Maximum 5.2 years
Methodological detailsnationwide, Medicare beneficiaries
- Nationwide
- Medicare beneficiaries
Main finding
As reported in the abstract
Cumulative incidence of LRVO
Patients developing LRVO
28,214
Cumulative incidence of LRVO
5.0%
Observational data: associations, not effects.
Further findings
Independent predictors of LRVO
| HR (95% CI) | ||
|---|---|---|
| CIEDs with >1 lead | 1.09 (1.07–1.15) | |
| Chronic kidney disease | 1.17 (1.14–1.20) | |
| Malignancies | 1.23 (1.20–1.27) | |
| 0.512Hazard ratio (log scale) |
| Outcome | Adjusted rate ratio (95% CI) | |
|---|---|---|
| LRVO-related health care utilizationExtractionvs Conservative managementAdjusted models | 0.58 (0.52–0.66) | |
| 0.512Adjusted rate ratio (log scale) |
Management of LRVO
- Managed conservatively
- 85.2%
- Underwent intervention
- 4,186 (14.8%)
- CIED extraction (of intervention)
- 74.0%
- Percutaneous revascularization (of intervention)
- 26.0%
- No new CIED after extraction
- 90%
- Leadless pacemaker use
- 2.2%
Original publication
Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction. J Am Coll Cardiol. Published 18 May 2023. doi:10.
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