March 27, 2023Open Access
Early Lead Extraction for Infected Implanted Cardiac Electronic Devices
Structured PICO
Does early and complete system and lead extraction improve clinical and economic outcomes in patients with cardiac implantable electronic device infection compared to no or late extraction?
P
Population
Patients with cardiac implantable electronic device infection (CIED-I)
I
Intervention
Complete system and lead removal/extraction
C
Comparator
No or late extraction
O
Outcome
Clinical and economic outcomes
Early and complete extraction of infected cardiac implantable electronic devices is associated with better clinical and economic outcomes, emphasizing the need to overcome barriers to timely intervention.
Abstract
Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.