Extraction and reimplantation of cardiac implantable electronic devices in patients with non-surgically treated infective endocarditis: a nationwide cohort study

Abstract Background Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) is associated with morbidity and mortality. Current guidelines recommend complete CIED extraction; however, the optimal timing for reimplantation remains uncertain. Purpose We aimed to evaluate CIED reimplantation rates, and outcomes in patients with non-surgically treated IE who underwent CIED extraction. Methods We included all Danish residents ≥18 years diagnosed with first-time IE (2010–2021), with a pre-existing CIED, who underwent CIED extraction without concurrent valve surgery. Data were obtained from Danish nationwide registries. The primary variable of interest was CIED reimplantation within 90 days after extraction. Reimplantation rates were described, and reimplantation status was used to stratify patients for analysis of secondary outcomes, including recurrent IE-related bacteraemia and all-cause mortality within six months. Results Among 661 patients with CIED extraction due to IE, 396 (59.9%) underwent reimplantation within three months, with a median of 29 days (IQR:19–42 days). There was no significant difference in the six-month cumulative incidence of recurrent bacteraemia with IE (2.5% 95% CI:0.95–5.5 vs. 1.8% 95% CI:0.8–3.6 p=0.55) or mortality (11.2% 95% CI:7.0–16.4 vs. 7.0% 95% CI:4.7–10.0; p =0.11) between non-reimplanted and reimplanted patients. Conclusion In IE patients who underwent CIED extraction, 60% of patients were reimplanted within three months with substantial variation in timing. No significant differences in outcomes were found by reimplantation status.