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Predictors of long-term survival free from relapses after extraction of infected CIED

Igor Diemberger1, Mauro Biffi1, Stefano Lorenzetti1

  • 1Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|October 11, 2017
PubMed

Insights

Transvenous lead extraction (TLE) for cardiac implantable device related infection (CIEDI) has a poor long-term prognosis. Renal failure, echo ghosts, and closed CIED pockets predict worse outcomes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Devices

Background:

  • Cardiac implantable electronic device (CIED) infections pose significant risks.
  • Transvenous lead extraction (TLE) is a crucial intervention for CIED infections.
  • Long-term prognosis after TLE for CIED infection requires further investigation.

Purpose of the Study:

  • To identify predictors of long-term prognosis following TLE for CIED infection.
  • To evaluate the association of the modified Duke score with patient outcomes.
  • To determine factors independently associated with mortality and CIEDI recurrence.

Main Methods:

  • Prospective observational study of 121 patients undergoing TLE for CIED infection.
  • Classification of CIED-related endocarditis using modified Duke criteria.
  • Cox regression analysis to identify independent predictors of poor prognosis.

Main Results:

  • The modified Duke score was associated with poor prognosis (HR 1.847).
  • Independent predictors of death and/or CIEDI recurrence included a closed CIED pocket (HR 2.720), presence of 'ghosts' on transoesophageal echocardiography (HR 3.469), and GFR < 60 (HR 4.565).
  • 20/121 patients died, and 7 experienced CIEDI recurrence/relapse during follow-up.

Conclusions:

  • CIED infections treated with TLE have a poor long-term prognosis.
  • Renal failure (GFR < 60), 'ghosts' on post-TLE echocardiography, and a closed CIED pocket are associated with worse outcomes.
  • Effective TLE does not guarantee favorable long-term prognosis in CIEDI patients.
Abstract

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