Key result
Epicardial leads linked to ~6-fold higher 1-year mortality versus system removal in CIED infections.
Why the study?
In CIED infections requiring device removal, maintaining a device-free interval for infection remediation is often not possible in pacemaker-dependent patients, and the ideal treatment strategy remains to be defined.
Does simultaneous contralateral CIED re-implantation or epicardial lead placement affect 1-year outcomes compared to system removal alone in patients undergoing CIED extraction for infection?
Cohort (n=190)
No
Does simultaneous contralateral CIED re-implantation or epicardial lead placement affect 1-year outcomes compared to system removal alone in patients undergoing CIED extraction for infection?
In pacemaker-dependent patients undergoing CIED extraction for infection, simultaneous contralateral reimplantation or epicardial lead placement may be viable strategies depending on the infection's severity and location.
Introduction: In CIED infections, all device material needs to be removed. But, especially in pacemaker-dependent patients it is often not possible to realize a device-free interval for infection remediation. In those patients, different treatment options are available, however the ideal solution needs still to be defined. Methods: This retrospective analysis includes 190 patients undergoing CIED extractions due to infection. Three different treatment algorithms were analyzed: Group 1 included 89 patients with system removal only (System removal group). In Group 2, 28 patients received an epicardial electrode during extraction procedure (Epicardial lead group) while 78 patients in group 3 (contralateral reimplantation group) received implantation of a new system contralaterally during extraction procedure. We analyzed peri- and postoperative data as well as 1-year outcomes of the three groups. Conclusion: In patients with CIED infection, systems should be removed completely and reimplanted after infection remediation. In pacemaker-dependent patients, simultaneous contralateral CIED re-implantation or epicardial lead placement may be performed, depending on route, severity and location of infection.
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Bürger et al. (2024) conducted a cohort in Cardiac implantable electronic device (CIED) infection (n=190). Epicardial lead placement during extraction vs. System removal only or contralateral reimplantation was evaluated on 1-year mortality (p=<0.001). In patients with CIED infections, 1-year mortality was 21.4% in the epicardial lead group compared to 3.4% in the system removal group and 4.1% in the contralateral reimplantation group.
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