Key result
Failed extraction of infected cardiac implantable electronic devices was a strong predictor for in-hospital mortality (HR 2.05) and resulted in significantly higher procedural complication rates.
Why the study?
Predictors of procedural success and outcomes were unclear in patients undergoing CIED extraction for systemic or local infection, particularly when complete lead removal cannot be achieved.
Does the degree of lead removal (complete, partial, or failed) affect in-hospital complications and mortality in patients with infected CIEDs?
Observational (n=1,863)
Yes
Does the degree of lead removal (complete, partial, or failed) affect in-hospital complications and mortality in patients with infected CIEDs?
Answers are grounded in this paper and cite their sources.
In patients with infected CIEDs, failure to remove >4 cm of the lead is associated with significantly increased risks of procedural complications and in-hospital mortality compared to complete or partial removal.
AIMS: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved. METHODS AND RESULTS: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046]. CONCLUSION: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates.
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Nof et al. (2019) conducted an observational in Infected cardiovascular implantable electronic devices (CIED) (n=1,863). Failed lead removal vs. Complete lead removal was evaluated on In-hospital mortality (HR 2.05, 95% CI 1.01-4.16, p=0.046). Failed extraction of infected cardiac implantable electronic devices was a strong predictor for in-hospital mortality (HR 2.05) and resulted in significantly higher procedural complication rates.
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