Sean D Pokorney, Xiaojuan Mi, Robert K Lewis, Melissa Greiner, Laurence M Epstein, Roger G Carrillo, Emily P Zeitler, Sana M Al-Khatib, Donald D Hegland, Jonathan P Piccini

Background -Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices (CIED); however, relatively little is known about long-term outcomes after capping and abandoning leads. Methods -Using the 5% Medicare sample, we identified patients with (1) de novo CIED implants between 1/1/2000 and 12/31/2013 and (2) a subsequent lead addition or extraction ≥12 months after the de novo implant. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years were compared for the extract versus the cap and abandon groups. Results -Among 6,859 patients, 1,113 (16.2%) underwent extraction, while 5,746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median 78 vs 79 years, p<0.0001), were less likely to be male (65% vs 68%, p=0.05), and had shorter lead dwell time (median 3.0 vs 4.0 years, p<0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25(th), 75(th) percentiles: 1.0, 4.3 years) the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% 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 HR 0.78, 95% CI 0.62-0.97, p=0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years. Conclusions -Elective lead extraction for non-infectious indications had similar long-term survival to capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.