Abstract
Introduction: Treating patients with CIED infections is often
challenging. In general, the infected device, including all leads, needs
to be completely removed before a new CIED can be implanted. Especially
in pacemaker-dependent patients, it is often impossible to have a
device-free interval to treat the infection. In those cases, the
question remains when to implant a new CIED and which bridging strategy
to use.
Methods: In this single-center retrospective analysis, we
included 190 patients who received a complete CIED system extraction
between 2013 and 2019 due to device-related infection. We compared three
different treatment algorithms. Group 1 (SR) included 89 patients who
received system removal only (and delayed re-implantation). Group 2 (EL)
consisted of 28 patients who were treated with lead extraction and
simultaneous epicardial lead implantation, while the 78 patients in
Group 3 (SI) received lead removal with simultaneous contralateral
implantation of a new device. We retrospectively analyzed the peri- and
postoperative course and one-year follow-up.
Results: Patients in the SR and EL groups were significantly
older, had more comorbidities and a higher percentage of systemic
infection compared to the SI group. We found a comparable high number of
successful infection treatments in all groups, with complete lead
removal in 95.5%, 96.4%, and 93.2% for the SR, EL, and SI groups,
respectively. Lead vegetations were removed in 97.7%, 94.1%, and
100%. Device re-implantation was 100% in the EL and SI groups, whereas
in the SR group, only 49.4% of patients received a device
re-implantation. At one-year follow-up, the percentage of freedom from
infection and pocket irritation was comparable between groups (94.7% SR
and EL, 100% SI). We observed no procedure-related mortality, while
one-year mortality was 3.4% in the SR, 21.4% in the EL and 4.1% in
the SI group.
Conclusion: We found comparable success rates regarding device
removal, successful infection treatment and perioperative course between
groups. However, most likely due to the sicker patient collective with a
high number of systemic infections, the one-year mortality was
significantly higher in the EL group. Treatment algorithm should be
selected due to type, severity, location of infection and comorbidities
of the patients.