Topaz et al (J Am Col Cardiol 2023;81:119, PMID 36631206) developed a technique for treating pocket infections in patients with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators who were deemed too high risk for lead and device extraction because of age, comorbidities, or frailty. The developed technique is a way to deliver continuous, in situ-targeted, ultrahigh concentration of antibiotics (CITA) directly into the pocket. The article describes the results in all patients treated with CITA between 2007 and March 2021 as a cohort study. Given promising early results, the investigators later expanded the indication to patients looking to avoid lead extraction. Patients approached for treatment with CITA had to have local infection without signs of systemic infection, such as fever, positive blood cultures, or vegetation on leads. The cohort of 80 patients treated with CITA were further divided into 3 groups: extraction prohibited owing to perceived high risk (n = 9), debatable indication for lead extraction such as possible infection (n = 6), and patients with pocket infection who could undergo extraction but who preferred CITA (n = 65). This final group was compared with 81 patients who underwent lead/device extraction for pocket infection in a case-control study.
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Published online: February 01, 2023
Funding Sources: The author has no funding sources to disclose.
Disclosures: The author has no conflicts of interest to disclose.
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