Transcutaneous lead implantation connected to an externalized pacemaker in patients with implantable cardiac...

Systemic cardiac implantable electronic device (CIED) infection is a serious complication, especially in patients with pacemaker (PM) dependency. In those patients after infectious device removal temporary pacing is necessary, to obtain adequate haemodynamics. In this study, a new therapy option with temporary pacing by ipsilateral implantation of a new active-fixation right ventricular (RV)-lead was evaluated.

Between September 2009 and November 2011, infectious lead removal was performed in 17 patients with systemic CIED infection. Temporary pacing was achieved by simultaneous implantation of a new active-fixation RV-lead, which then was connected extracorporally to the old CIED device. Antibiotic therapy was initiated. When laboratory infection parameters were in normal range and blood culture samples showed negative results, new CIED was implanted on contralateral side and temporary RV-lead was removed. Mean patients' age was 71.3 ± 9.1 years. Mean C-reactive protein values were 79.3 mg/dL, and mean leucocytes counts were 12.6 × 10(3). After lead extraction, temporary pacing was necessary in all patients due to severe bradycardia. Mean duration of temporary pacing was 12.7 (6-24) days. No major procedure-related peri- or post-operative adverse events occurred. Mean time of hospitalization was 20.8 (10-48) days. Mean follow-up time was 21.1 months (12-36), showing survival rate of 100% and freedom from reinfection in all patients.

Ipsilateral implantation of a temporary active-fixation RV-lead connected to an externalized PM and pursued antibiotic therapy seems to be a good option for patients with CIED infection and PM dependency, showing no temporary pacing-related complications and no reinfection after mean follow-up time of 21.1 months.