Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices

• Published in: JACC. Clinical electrophysiology 2020-06, Vol.6 (6), p.672-680
• Main Authors: Black-Maier, Eric, Piccini, Jonathan P., Bishawi, Muath, Pokorney, Sean D., Bryner, Benjamin, Schroder, Jacob N., Fowler, Vance G., Katz, Jason N., Haney, John C., Milano, Carmelo A., Nicoara, Alina, Hegland, Donald D., Daubert, James P., Lewis, Robert K.
• Format: Article
• Language: English
• Subjects: cardiovascular implantable electronic device infection; lead extraction; left ventricular assist device
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2020.02.006

The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). The use of transvenous lead extraction for the management CIED infection in patients with a durable LVAD has not been well described. Clinical and outcomes data were collected retrospectively among patients who underwent lead extraction for CIED infection after LVAD implantation at Duke University Hospital. Overall, 27 patients (n = 6 HVAD; n = 15 HeartMate II; n = 6 Heartmate III) underwent lead extraction for infection. Median (interquartile range) time from LVAD implantation to infection was 6.1 (2.5 to 14.9) months. Indications included endocarditis (n = 16), bacteremia (n = 9), and pocket infection (n = 2). Common pathogens were Staphylococcus aureus (n = 10), coagulase-negative staphylococci (n = 7), and Enterococcus faecalis (n = 3). Sixty-eight leads were removed, with a median lead implant time of 5.7 (3.6 to 9.2) years. Laser sheaths were used in all procedures, with a median laser time of 35.0 s (17.5 to 85.5s). Mechanical cutting tools were required in 11 (40.7%) and femoral snaring in 4 (14.8%). Complete procedural success was achieved in 25 (93.6%) patients and clinical success in 27 (100%). No procedural failures or major adverse events occurred. Twenty-one patients (77.8%) were alive without persistent endovascular infection 1 year after lead extraction. Most were treated with oral suppressive antibiotics after extraction (n = 23 [82.5%]). Persistent infection after extraction occurred in 4 patients and was associated with 50% 1-year mortality. Transvenous lead extraction for LVAD-associated CIED infection can be performed safely with low rates of persistent infection and 1-year mortality. [Display omitted]