Key result
Temporary ipsilateral subclavian pacing after infected lead extraction shows no major complications and ~8% infection relapse.
Why the study?
Pacemaker-dependent patients require temporary pacing after transvenous lead extraction for device infection, but alternative access options when other sites are unavailable remain limited.
Does temporary pacing using the ipsilateral subclavian access provide a safe alternative in patients undergoing transvenous lead extraction for device infection?
Observational (n=36)
No
Does temporary pacing using the ipsilateral subclavian access provide a safe alternative in patients undergoing transvenous lead extraction for device infection?
Temporary pacing using the ipsilateral subclavian access with a permanent active fixation lead is a feasible alternative after lead extraction, though associated with an 8.3% long-term relapse of local pocket infection.
Supports feasibility of ipsilateral access post-extraction; leaves open comparative safety versus alternatives in randomized trials.
Background: Temporary pacing is necessary in pacemaker-dependent patients after transvenous lead extraction (TLE) for cardiac implantable electronic device infection. In case of unavailability of other accesses, we propose to use the ipsilateral subclavian access (ISA) combined with a standard permanent active fixation lead for the temporary pacemaker and present preliminary data. Methods: We consecutively enrolled patients undergoing TLE who received a temporary pacemaker using the ISA between August 2016 and April 2020 at our centre. Results: During the observation period, 36 patients undergoing TLE for pocket infection (72.2%), endocarditis (25.0%) or other causes received a temporary pacemaker over the ISA. Their mean age was 77.0 ± 10.7 years, and 13.9% were female. Complete TLE was achieved in 94.4%. There were no major periprocedural complications. Intra-hospital mortality was 11.1%. Pocket revision was performed in 19.4%. During long-term follow-up (23 ± 13 months), 8.3% had a relapse of local pocket infection and 2.8% needed rehospitalization for reintervention. Conclusions: Temporary pacing using a standard permanent active fixation lead using the ISA is a convenient alternative to conventional venous accesses. However, risks of implanting a lead into a previously infected area have to be taken into account.
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Zweiker et al. (2022) conducted an observational in Cardiac implantable electronic device infection requiring transvenous lead extraction (n=36). Temporary pacing using ipsilateral subclavian access with a standard permanent active fixation lead was evaluated on Relapse of local pocket infection. Temporary pacing via the ipsilateral subclavian access after lead extraction for infection resulted in no major periprocedural complications and an 8.3% relapse of local pocket infection.
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