56-57: Prognosis of second CRT implantation after complete device extraction

Background: The number of complete CRT device and lead extraction is growing over the last years. Caused by thrombosis in vena subclavia, vena cava superior or coronary sinus branch (CS) and other complication of infection the second CRT implantation is more sophisticated. Methods: Since 2007 to 2015 n = 1712 lead extraction in n = 537 patients were performed in our center. In n = 125 of these patients a CS lead extraction was necessary. In n = 62 of these patients a second CRT implantation was performed [♂ n = 55: ♀ n = 7; age 68 ± 10 years; DCM n = 28 and CAD n = 34; LVEF 27 ± 7 % NT-proBNP 2,651 pg/ml (1,248-4,813)]. Result: The median time interval from extraction to second CRT implantation was 58 (48-90) days and the median follow up interval after second CRT implantation was 533 (421-1053) days. In 9 patients the second CRT implantation failed. The success rate of second CRT implantation was 85 % (n = 53 patients). But only in 28 patients (45 %) the previous already used posterolateral CS branch could reach for stable CS lead implantation. Further only n = 8 of 34 (23.5 %) patients with oral anticoagulation compared to n = 20 of 28 (71.4 %) patients without oral anticoagulation had a thrombosis in previous already used CS branch [p = 0.001 OR 7,8 95% CI 2,6-26].The all-cause mortality after one, two and three years were 7.1%, 15.9% and 25.2%. The all-cause mortality in patients with staphylococcus aureus in the blood culture was significant higher compared to all-cause mortality in patients with other bacteria or without bacteria in blood culture (p = 0.014).