An alternative to transvenous lead extraction in selected patients with CIED infections: a retrospective outcome study

Abstract

Funding Acknowledgements Type of funding sources: None. Background Cardiac implantable electronic devices (CIED) implants are rising in an older, more co-morbid population [1]. The prevalence of CIED infection ranges from 1-4% [2, 3]. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded or pre-eroding CIEDs [4], this approach is not without risk [5] and may be unacceptable to some patients [6]. Long term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients. Method A retrospective review of all CIED revision procedures at a large tertiary centre, over a 7-year period was undertaken with a mean follow up of 39 months. Results 86 patients underwent 96 revision procedures. 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of follow up. There was no in hospital mortality and all patients were alive at 30 days. Overall mortality at 12 months was 8.1% (7 deaths), increasing to 24.4% (21 deaths) at end of follow up. Conclusion Our data provides important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication free at 12 months.