Early Versus Delayed Lead Extraction in Patients With Infected Cardiovascular Implantable Electronic Devices

• Published in: JACC. Clinical electrophysiology 2021-06, Vol.7 (6), p.755-763
• Main Authors: Lin, Andrew Y., Saul, Tatiana, Aldaas, Omar M., Lupercio, Florentino, Ho, Gordon, Pollema, Travis, Pretorius, Victor, Birgersdotter-Green, Ulrika
• Format: Article
• Language: English
• Subjects: cardiovascular implantable electronic device; CIED infection; Defibrillators, Implantable - adverse effects; Device Removal; Electronics; Humans; implantable cardioverter-defibrillator; lead extraction; Pacemaker, Artificial - adverse effects; permanent pacemaker; Prosthesis-Related Infections - epidemiology
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2020.11.003

This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED). CIED infections are associated with poor outcomes. Prior studies have demonstrated improved survival with CIED extraction compared with antibiotic therapy alone. The impact of timing of CIED extraction has not been well characterized. All infected CIED extraction cases at our medical center from 2006 to 2019 were reviewed. Patients were divided into 2 groups based on the presence of bacteremia or isolated pocket infection. We assessed the in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, using hospitalization day 7 as cutoff. Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Delayed extraction (15.2 days) in bacteremic patients was associated with septic shock (odds ratio [OR]: 5.39; 95% confidence interval [CI]: 1.23 to 23.67; p = 0.026), acute kidney injury (OR: 5.61; 95% CI: 2.15 to 14.63; p