Early Lead Extraction for Infected Implanted Cardiac Electronic Devices

Lakkireddy, Dhanunjaya; Segar, Douglas S.; Sood, Ami; Wu, MaryAnn; Rao, Archana; Sohail, M. Rizwan; Pokorney, Sean D.; Blomström‐Lundqvist, Carina; Piccini, Jonathan P.; Granger, Christopher B.

doi:10.1016/j.jacc.2023.01.038

Cited by 15 publications

(8 citation statements)

References 46 publications

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“…One reason for delayed transfer may be an identification barrier of device infection, related to the lack of physician knowledge and awareness, as was described by Lakkireddy et al 25 and by Sood and colleagues. 26 One strategy to minimize this barrier is by education and sharing of evidence.…”

Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Özkartal,

Demarchi,

Conte

et al. 2024

European Heart Journal

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Background and Aims Bloodstream infection (BSI) of any cause may lead to device infection in cardiac implantable electronic device (CIED) patients. Aiming for a better understanding of the diagnostic approach, treatment, and outcome, patients with an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with BSI were investigated. Methods This is a single-centre, retrospective, cohort analysis including consecutive ICD/CRT-D patients implanted between 2012 and 2021. These patients were screened against a list of all hospitalized patients having positive blood cultures consistent with diagnosed infection in any department of a local public hospital. Results The total cohort consisted of 515 patients. Over a median follow-up of 59 months (interquartile range 31–87 months), there were 47 BSI episodes in 36 patients. The majority of patients with BSI (92%) was admitted to non-cardiology units, and in 25 episodes (53%), no cardiac imaging was performed. Nearly all patients (85%) were treated with short-term antibiotics, whereas chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less frequent. Patients with BSI had a nearly seven-fold higher rate (hazard ratio 6.7, 95% confidence interval 3.9–11.2; P < .001) of all-cause mortality. Conclusions Diagnostic workup of defibrillator patients with BSI admitted to a non-cardiology unit is often insufficient to characterize lead-related endocarditis. The high mortality rate in these patients with BSI may relate to underdiagnosis and consequently late/absence of system removal. Efforts to increase an interdisciplinary approach and greater use of cardiac imaging are necessary for timely diagnosis and adequate treatment.

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Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Özkartal,

Demarchi,

Conte

et al. 2024

European Heart Journal

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“…Although there are no randomized controlled trials to determine the optimal timing of complete device removal, there are supportive survival data for early CIED extraction. 44,45 In the study by Le et al, 46 immediate CIEDI removal within 7 days of diagnosis compared with a delay in removal was associated with a 3-fold decrease in 1-year mortality (hazard ratio, 0.35 [95% CI, 0.16–0.75]).…”

Section: Managementmentioning

confidence: 99%

“…2 Although there are no randomized controlled trials to determine the optimal timing of complete device removal, there are supportive survival data for early CIED extraction. 44,45 In the study by Le et al, 46 immediate CIEDI removal within 7 days of diagnosis compared with a delay in removal was associated with a 3-fold Empiric antibiotic therapy is only for use in a superficial incisional site infection, including a stitch abscess where device infection is not present. The device can be retained, and the superficial infection treated with a course of oral antimicrobial therapy.…”

Section: Managementmentioning

confidence: 99%

Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association

Baddour,

Esquer Garrigos,

Rizwan Sohail

et al. 2024

Circulation

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The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.

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“…These include lead-related central vein injury leading to a massive haemothorax, cardiac perforation resulting in tamponade, vascular thrombosis and embolisms [ 15 , 16 ]. Chronic complications are particularly relevant to young patients, namely structural damage, lead failure and infection warranting lead extraction, which is a complex procedure with serious complications such as vessel injury, a massive haemothorax, valve damage, cardiac perforation, tamponade and death [ 156 , 157 ].…”

Section: Icd Cost Reductionmentioning

confidence: 99%

Implantable Cardioverter Defibrillator Tachycardia Therapies: Past, Present and Future Directions

Leong,

Arnold,

Whinnett

2024

JCDD

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Implantable cardioverter defibrillators (ICDs) have a long history and have progressed significantly since the 1980s. They have become an essential part of the prevention of sudden cardiac death, with a proven survival benefit in selected patient groups. However, with more recent trials and with the introduction of contemporary heart failure therapy, there is a renewed interest and new questions regarding the role of a primary prevention ICD, especially in patients with heart failure of non-ischaemic aetiology. This review looks at the history and evolution of ICDs, appraises the traditional evidence for ICDs and looks at issues relating to patient selection, risk stratification, competing risk, future directions and a proposed contemporary ICD decision framework.

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Early Lead Extraction for Infected Implanted Cardiac Electronic Devices

Cited by 15 publications

References 46 publications

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association

Implantable Cardioverter Defibrillator Tachycardia Therapies: Past, Present and Future Directions

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