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.