Key result
Canadian physicians favor conservative management in up to ~93% of high-risk CIED bacteremia cases.
Why the study?
Management of patients with CIEDs and Staphylococcus aureus bacteremia of unknown origin varies across institutions despite guideline recommendations, and contemporary practice patterns remain poorly characterized.
Cross-Sectional (n=27)
Yes
There is substantial national heterogeneity in the management of unexplained Staphylococcus aureus bacteremia in CIED patients, with decision-making heavily influenced by perceived procedural risk despite guideline recommendations.
Marked variation in CIED extraction for SAB persists; leaves open optimal management and supports prospective standardization trials.
Background Management of patients with cardiac implantable electronic devices (CIEDs) and Staphylococcus aureus bacteremia (SAB) of unknown origin varies across institutions, despite guideline recommendations supporting complete system removal. Contemporary practice patterns remain poorly characterized. Our objective was to evaluate national variation in lead extraction decision-making for SAB and identify factors influencing clinical management. Methods In 2024, a 13-question national survey was distributed to members of the Canadian Heart Rhythm Society Device Committee. The survey assessed extraction thresholds, timing, imaging, procedural planning, and perceived need for a randomized clinical trial. Results Responses were obtained from 27 physicians representing 16 of 21 (76%) centers across five provinces. Of respondents, 22/27 (81%) were affiliated with centers performing CIED extraction, and 10/27 (37%) directly performed extractions. Most respondents favored conservative management (antibiotics with or without selective extraction) for patients at very high and high extraction-related procedural risk (92.5% and 77.8%, respectively). Greater equipoise was observed at lower procedural risk: 45% recommended extraction in moderate-risk patients and 63% in low-risk patients. Practice patterns demonstrated substantial heterogeneity according to perceived procedural risk and center extraction volume. Overall, 75% of respondents believed a randomized trial would be beneficial. Conclusions Substantial variability exists in the management of SAB in patients with retained CIED hardware and no evidence of vegetation. Management decisions are strongly influenced by perceived extraction risk and institutional experience. These findings demonstrate clinical equipoise and support the need for a randomized trial to define the optimal management strategy and improve patient outcomes.
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Golian et al. (2026) conducted a cross-sectional in Staphylococcus aureus bacteremia in patients with cardiac implantable electronic devices (n=27). Survey on lead extraction practices was evaluated on Preferred clinical management strategy based on perceived procedural risk. Most surveyed Canadian physicians favored conservative management for CIED patients with SAB at very high (92.5%) and high (77.8%) extraction risk, highlighting substantial practice heterogeneity.
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