Intracardiac lead abrasion is one of the most common factors influencing the occurrence of ILV. Metabolic disorders in patients with RF, heart failure, defibrillation leads, and loops of the leads were found to contribute to the formation of large vegetations. In LRIE patients, ILVs were less frequently detected in the presence of concomitant PI, indicating a different mechanism of LRIE development in patients with and without vegetations.

597has been rising due to an increasing number of ICD or CRT device implantations in a specif ic population of patients with severe heart fail ure (HF) and comorbidities. Furthermore, re cent years have witnessed a tremendous increase in average life expectancy, which translates into a higher number of reinterventions (generator re placement, system upgrade) in patients receiving CIEDs. 2-6 A significant increase in the incidence INTRODUCTION Cardiac implantable electron ic device (CIED) infections, which develop in pa tients with pacemakers, implantable cardiovert er-defibrillators (ICDs), and cardiac resynchro nization therapy (CRT) devices, pose a major clinical challenge. The incidence of these infec tions is estimated to range from 1% to 2% in pa tients with CIEDs.1 However, these data are inac curate because the incidence of CIED infections OBJECTIVES The aim of this study was to assess the risk factors and long term survival of patients with CIED infections. PATIENTS AND METHODSWe analyzed the clinical data of 1837 patients (including xx [40.9%] patients with CIED infections), who underwent transvenous lead extraction at a single institution between 2006 and 2015. We compared the clinical and procedure related factors for all types of CIED infections: iso lated pocket infection (IPI), isolated lead related infective endocarditis (ILRIE), and lead related infective endocarditis with coexisting pocket infection (LRIE + PI). We also analyzed long term survival rates. RESULTSThe development of IPI and LRIE + PI depended mainly on age, male sex, number of leads, presence of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT D), and the number of previous procedures. The factors that determined ILRIE included chronic renal failure (CRF), ICD/CRT D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against the development of infection. Long term survival was significantly related to age, heart failure, diabetes mellitus, CRF, malignancy, and chronic atrial fibrillation.CONCLUSIONS The development of all types of CIED infection was associated mainly with procedure related factors, while long term mortality was dependent on clinical factors. The dissimilarity of factors affecting the development of IPI and ILRIE confirms that there are 2 variants of CIED infection. The pro tective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in the prevention of CIED infection.

Background: Cardiac implantable electronic devices (CIED) are very rare in the pediatric population. In children with CIED, transvenous lead extraction (TLE) is often necessary. The course and effects of TLE in children are different than in adults. Thus, this study determined the differences and specific characteristics of TLE in children vs. adults. Methods and Results:A post hoc analysis of TLE data in 63 children (age ≤18 years) and 2,659 adults (age ≥40 years) was performed. The 2 groups were compared with respect to risk factors, procedure complexity, and effectiveness. In children, the predominant pacing mode was a single chamber ventricular system and lead dysfunction was the main indication for lead extraction. The mean implant duration before TLE was longer in children (P=0.03), but the dwell time of the oldest extracted lead did not differ significantly between adults and children. The duration (P=0.006) and mean extraction time per lead (P<0.001) were longer in children, with more technical difficulties during TLE in the pediatric group (P<0.001). Major complications were more common, albeit not significantly, in children. Complete radiographic and procedural success were significantly lower in children (P<0.001).Conclusions: TLE in children is frequently more complex, time consuming, and arduous, and procedural success is more often lower. This is related to the formation of strong fibrous tissue surrounding the leads in pediatric patients.

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IntroductionSpontaneous lead dislodgement into the pulmonary circulation is a rare complication of permanent pacing with unproven harmfulness and an indication of controversial class for transvenous lead extraction (TLE).AimTo assess TLE safety in patients with leads dislodged into the pulmonary artery.Material and methodsA retrospective analysis of a 9-year-old database of transvenous lead extraction procedures comprising 1767 TLEs was carried out, including a group of 19 (1.1%) patients with leads dislodged into the pulmonary artery (LDPA).ResultsUnder univariate analysis the factors that increased the likelihood of the presence of an electrode in the pulmonary artery were mean lead dwelling time (increase of risk by 9% per year), total number of leads in the heart before TLE (increase of risk by 66% for one lead) and the number of abandoned leads (increase of risk by 119%). The presence of LDPA was associated with frequent occurrence of intracardiac lead abrasion (increase by 316%) and isolated lead-related infective endocarditis (LRIE) (increase by 500%). There were no statistically significant differences in clinical (p = 0.3), procedural (p = 0.94) or radiological (p = 0.31) success rates in compared (LDPA and non-LDPA) groups. Long-term mortality after TLE was comparable in both groups.ConclusionsAs the effectiveness and safety of TLE in patients with LDPA are comparable to those in standard TLE procedures, in our opinion, such patients should be considered TLE candidates.