Background
The rate of transvenous lead extraction (TLE) due to cardiac implantable electronic
device (CIED) infection continues to rise. CIED infections are associated with significant
morbidity and mortality. Temporary pacing in patients with active CIED infections
after TLE can be challenging. Leadless pacing has emerged as an alternative approach
in this patient population.
Objective
The purpose of this study was to describe the outcomes of a strategy using concomitant
leadless pacemaker implantation and TLE in patients with active infections and ongoing
pacing requirements.
Methods
This study involved all leadless pacemaker implantation procedures performed during
TLE between June 2018 and September 2022 in the setting of active infection. Demographic
characteristics, procedural details, and clinical outcomes were analyzed.
Results
The study included 86 patients with indications for ongoing pacing, 60 (70%) men with
mean age 77.4 ± 10.5 years, who underwent TLE and concomitant leadless pacemaker implantation
in the setting of active infection. There were no procedure-related complications.
Sixty-five patients (76%) had evidence of bacteremia, 80% of whom were discharged
to complete their antimicrobial treatment. During a median follow-up of 163 days (interquartile
range 57–403 days), there were no recurrent infections. Of the 25 deaths (29%) during
the study period, 22 (88%) were unrelated to the initial infection. Nine deceased
patients (36%) had methicillin-resistant Staphylococcus aureus or Candida infections, 3 of whom had persistent infection despite TLE.
Conclusion
Leadless pacing is a safe and efficacious approach for the management of patients
with pacing requirements that undergo CIED extraction in the setting of active infection.
Keywords
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Article info
Publication history
Published online: February 08, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: The authors have no conflicts of interest to disclose.
Identification
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© 2023 Heart Rhythm Society. All rights reserved.
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- Leadless pacing in patients undergoing transvenous lead extraction due to infection: A small step in a long journeyHeart Rhythm
- PreviewImprovement in technology and expansion of indications have led to a progressive increase in the implantation of cardiovascular implantable electrical devices (CIED). This trend is accompanied by a rise in CIED-related complications, particularly device-related infections (DRIs), which are associated with a significant impact on patient prognosis and health care–associated costs.1,2 In the case of DRI, current guidelines give a class I indication to complete system removal using a transvenous lead extraction (TLE) approach.
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