Improvement 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.
- Diemberger I.
- Segreti L.
- Rinaldi C.A.
- et al.
on behalf of the ELECTRa Investigators. Transvenous lead extraction in patients with
cardiac implantable device: the impact of systemic and local infection on clinical
outcomes—An ESC-EHRA ELECTRa (European Lead Extraction Controlled) Registry Substudy.
Biology (Basel). 2022; 11: 615
3
Until recent years, most of the focus of the management of DRI was related to the
TLE procedure itself. Physicians, researchers, and industry all have invested tremendous
resources into improving periprocedural outcomes, aiming to increase the success rate
as well as to decrease the complexity of the procedure. In addition, efforts were
made to reduce the rate of DRI and implantation complications.
4
However, little has been done to optimize the postprocedural course following TLE,
especially in DRI patients. Recent literature has shown that, although the timing
of TLE and the periprocedural outcomes are of significant relevance for prognosis,
postprocedure mortality remains several times higher than procedure-related mortality,
reaching 30% at 1 year post-TLE in DRI patients.
5
,
6
,
7
This information has a significant impact on post-TLE management, including reimplantation
strategies. The timing of reimplantation becomes even more challenging in patients
who are pacing dependent, those with cardiac resynchronization therapy (CRT), and
those with secondary prevention defibrillators with increased risk of ventricular
tachyarrhythmias and sudden cardiac death. In the setting of DRI, the optimal timing
of CIED reimplantation for these patients after successful TLE currently is unknown.To read this article in full you will need to make a payment
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References
- Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003.J Am Coll Cardiol. 2006; 48: 590-591
- on behalf of the ELECTRa Investigators. Transvenous lead extraction in patients with cardiac implantable device: the impact of systemic and local infection on clinical outcomes—An ESC-EHRA ELECTRa (European Lead Extraction Controlled) Registry Substudy.Biology (Basel). 2022; 11: 615
- 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction.Heart Rhythm. 2017; 14: e503-e551
- Antibacterial envelope to prevent cardiac implantable device infection.N Engl J Med. 2019; 380: 1895-1905
- Risk factors for repeat infection and mortality after extraction of infected cardiovascular implantable electronic devices.JACC Clin Electrophysiol. 2021; 7: 1182-1192
- Causes of early mortality after transvenous lead removal.JACC Clin Electrophysiol. 2022; 8: 1566-1575
- Characterization of a previously unrecognized clinical phenomenon: delayed shock after cardiac implantable electronic device extraction.Heart Rhythm. 2017; 14: 1552-1558
Beccarino NJ, Choi EY, Liu B, et al. Concomitant leadless pacing in pacemaker-dependent patients undergoing transvenous lead extraction for active infection: mid-term follow-up. Heart Rhythm 202X;XX:XXX–XXX.
- Bacteraemia after leadless pacemaker implantation.J Cardiovasc Electrophysiol. 2020; 31: 2440-2447
- Leadless pacemaker implantation after explantation of infected conventional pacemaker systems: a viable solution?.Heart Rhythm. 2019; 16: 66-71
- Leadless pacemakers reduce risk of device-related infection: review of the potential mechanisms.Heart Rhythm. 2020; 17: 1393-1397
Article info
Publication history
Published online: February 27, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: The authors have no funding sources to disclose. Disclosures: Dr Wilkoff has received research grants and/or consultancy fees from Abbott, Medtronic, Boston Scientific, Biotronik, Philips, and Cook. Dr Younis has no conflicts of interest to disclose.
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© 2023 Heart Rhythm Society. All rights reserved.
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- Concomitant leadless pacing in pacemaker-dependent patients undergoing transvenous lead extraction for active infection: Mid-term follow-upHeart Rhythm
- PreviewThe 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.
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