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Lead extraction for device related infections: a single-centre experience
F A L E Bracke1, A Meijer, L M van Gelder
1Department of Cardiology, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands. frank.bracke@cze.nl
Summary
Lead extraction effectively cures infections related to pacemakers and implantable cardioverter-defibrillators (ICDs), even when other treatments fail. However, this procedure carries a significant risk of complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Infections associated with cardiac electronic devices like pacemakers and ICDs pose a significant clinical challenge.
- Management often involves systemic antibiotics, but lead extraction may be necessary for persistent or severe infections.
Purpose of the Study:
- To evaluate the efficacy and safety of lead extraction in patients with infected pacemaker and ICD leads at a single center.
- To assess outcomes following lead extraction, including cure rates, complications, and long-term pacing status.
Main Methods:
- A retrospective review of consecutive lead extraction procedures performed for infection was conducted.
- Leads were extracted using traction or laser sheath techniques in an operating room setting.
- Patient data, including demographics, procedural details, complications, and follow-up, were analyzed.
Main Results:
- Eighty-two patients underwent lead extraction, with 80% of infections occurring after generator replacement or lead revision.
- Lead extraction successfully cured infection in all patients, with no recurrence observed during follow-up (mean 27 months).
- Major complications occurred in 6 patients, and 2 patients died despite emergency surgery; one additional death was due to sepsis.
Conclusions:
- Lead extraction is an effective treatment for eradicating pacemaker and ICD-related infections, even in cases of failed conservative management.
- The procedure is associated with a notable complication rate, including mortality.
- Reconsideration of routine generator replacement in patients with a no-longer-valid pacing indication is warranted to prevent device-related infections.