Survival of patients with cardiac implantable electronic device infections after transvenous lead extraction

BACKGROUND: Cardiac implantable electronic device (CIED) infections, particularly CIED-associated infective endocarditis (CIED-associated IE), are associated with a high 1-year mortality rate of 14%-35%, reduced quality of life, and increased burden on the healthcare system. AIMS: In this prospective, single-center, high-volume referral study, we aimed to analyze and compare 3 groups of patients who underwent transvenous lead extraction (TLE): patients with CIED-associated IE, patients with pocket infection (PI), and both. METHODS: This study included all consecutive patients with CIEDs who underwent TLE due to device-related infection at a tertiary referral hospital between 2011 and 2023. Patients were divided into 3 groups (CIED-associated IE, PI, and both indications) based on the modified Duke criteria. RESULTS: A total of 253 consecutive patients underwent TLE. Of these, 135 (53%) were treated for PI, 90 (36%) for CIED-associated IE, and 28 (11%) for both indications. Almost all procedures (97%) were completed without complications. Patients with CIED-associated IE had significantly higher mortality than patients in the CIED-associated IE + PI group, and patients in the PI group had the lowest mortality. One-year, 2-year, and 5-year overall survival rates in the CIED-associated IE group were 61%, 49%, and 32%, respectively, compared with 77%, 73%, and 56% in the CIED-associated IE + PI group and 90%, 86%, and 67% in the PI group (P <0.001). CONCLUSIONS: Patients with CIED-associated IE had almost 4-fold higher 1-year mortality compared to those with PI. Patients with CIED-associated IE and PI had about 2-fold higher 1-year mortality compared to those with PI.