Conclusion
The study authors were able to confirm that in cases of severe bloodstream infections with generalized sepsis, complete removal of infected CIED systems should be performed according to international recommendations. In the absence of pacemaker dependency, our study showed a good long-term prognosis with low mortality after two-stage reimplantation.
On the other hand, in pacemaker-dependent patients, treatment strategies should be carefully considered, taking into account infection routes and localization, implant age, and existing comorbidities. For example, in localized, non-systemic pocket infections, simultaneous implantation of a contralaterally implanted CIED system can lead to rapid recovery with short hospital stay and low long-term mortality with good outcomes. Here, the authors found no significant differences in prognosis and reinfection rates between these two procedures. In contrast, for severe generalized bloodstream infections in pacemaker-dependent patients, implantation of an epicardial lead during extraction procedures to maintain pacing is a successful treatment option. However, mortality was significantly higher in this collective during hospitalization and at 1-year follow-up compared with other study groups - but the patients studied were also sicker. Whether the promising alternative of a temporarily implanted percutaneous pacing electrode or the implantation of a leadless pacemaker is a serious treatment option, on the other hand, remains to be clarified by further studies.