A case control study comparing long term outcomes of devices implanted via femoral vs conventional superior access

Background: The conventional route to insert cardiac implantable electronic devices (CIED) is not always possible. Devices implanted via the femoral route (F-CIED) remain an alternative option despite the advent of leadless and subcutaneous devices. However, the long-term outcomes of F-CIED, in particular complex F-CIED (implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) devices)), are not known. Furthermore, the feasibility and safety of extracting chronic femoral leads has not been reported. Methods: All patients with F-CIED implanted between 2002-2019 at two high volume tertiary centres were included in the study. A total of 31 F-CIED (10 complex – ICD and CRT – and 21 simple – single and dual chamber pacemakers) were compared 1:3 to 93 matched controls of conventional devices implanted via superior venous access (C-CIED). Complications requiring intervention were classified as early (30 days) following implant. Results: Early complications were similar between F-CIED and C-CIED (6% vs 5%; p=0.85) and between complex F-CIED and simple F-CIED sub-groups (10% vs 5%; p=0.58). Late complications at 7.5 ± 4.9 years follow-up were higher with F-CIED compared to C-CIED (29% vs 11.6%; p