Cardiac Rhythm Disorders

Pacemaker and Implantable Cardioverter Defibrillator (ICD) Implants

Lead Extraction Procedures Volume, Success, and Major Complications

2014 — 2018

Electrophysiologists at Cleveland Clinic perform a high number of lead extractions. Many of these patients have complex conditions that result in referral to Cleveland Clinic physicians. Leads may need removal because of electrical malfunctions, blocked blood vessels, or infection. In most cases, the leads can be removed without opening the chest or heart. Major complications are defined as those causing death or intrathoracic bleeding.

A total of 905 lead extraction procedures were performed to remove 1675 leads at Cleveland Clinic from 2014 through 2018. The overall clinical success rateᵃ was 97.7%, and the rate of major complications was 1.7%.

ᵃClinical success is defined as the removal of all the required leads without causing bleeding from the veins or heart.

Device Clinic Evaluations Volume

2018, N = 54,452

Cleveland Clinic was the first hospital in the country to integrate a patient database for pacemaker and implantable cardioverter defibrillator follow-up with electronic medical records. This innovative approach to follow-up allows staff to keep track of patients’ health conditions regardless of the patient's location. Remote monitoring is also associated with increased longevity and decreased need for in-person follow-up.

The Miller Family Heart & Vascular Institute uses the MyChart® function in Epic, Cleveland Clinic’s electronic medical record system, to quickly notify patients of their device status.

Evaluation Type N
Pacemaker evaluations 22,028
ICD evaluations 25,546
Implantable loop recorders 6,878

ICD = implantable cardioverter defibrillator

Secondary Implantation Complications: Pacemaker and Implantable Cardioverter Defibrillator

2018, N = 406

In 2018, Cleveland Clinic doctors performed 406 secondary pacemaker and implantable cardioverter defibrillator (ICD) implants. The complication rates for all procedures were below the benchmark rates.

Complication N Major Complication (Percent of Patients) Benchmark (%) (1)
ICD with lead addition 103 1.9 17.4
ICD without lead addition 177 1.1 5.8
Pacemaker with lead addition 44 4.6 5.9
Pacemaker without lead addition 82 1.2 2.3

Reference

  1. Poole et al. REPLACE Registry Investigators. Complication rates associated with pacemaker or implantable cardioverter defibrillator generator replacements and upgrade procedure: results from the REPLACE registry. Circulation. 2010 October 19; 122(16):1553-1561.