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Early Versus Delayed Lead Extraction in Patients With Infected Cardiovascular Implantable Electronic Devices
Andrew Y Lin1, Tatiana Saul1, Omar M Aldaas1
1Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
Insights
Prompt cardiovascular implantable electronic device (CIED) lead extraction is crucial. Delayed extraction in infected CIED patients significantly increases risks of severe complications and 1-year mortality, highlighting the need for timely intervention.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Management
Background:
- Cardiovascular implantable electronic device (CIED) infections lead to adverse patient outcomes.
- While CIED extraction improves survival over antibiotics alone, the optimal timing remains unclear.
- Understanding the impact of extraction timing is critical for managing CIED infections.
Purpose of the Study:
- To evaluate the impact of early versus delayed lead extraction in patients with infected CIEDs.
- To compare in-hospital morbidity and 1-year mortality between early and delayed extraction groups.
Main Methods:
- Retrospective review of infected CIED extraction cases (2006-2019).
- Patients categorized by bacteremia or isolated pocket infection.
- Extraction timing assessed relative to hospitalization day 7; outcomes included in-hospital morbidity and 1-year mortality.
Main Results:
- Delayed extraction (15.2 days) in bacteremic patients correlated with septic shock, acute kidney injury, respiratory failure, and heart failure.
- Delayed extraction (10.7 days) in pocket infection patients correlated with acute kidney injury and respiratory failure.
- Delayed CIED extraction in both groups was linked to increased 1-year mortality.
Conclusions:
- Delayed infected CIED extraction is associated with significantly worse patient outcomes.
- Early detection and prompt lead extraction are vital for managing CIED infections.
- A strategy emphasizing timely intervention improves patient survival and reduces complications.
Objectives:
This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED).
Background:
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.
Methods:
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.
Results:
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 < 0.001), respiratory failure (OR: 5.52; 95% CI: 1.25 to 24.41; p = 0.024), and decompensated heart failure (OR: 3.32; 95% CI: 1.10 to 10.05; p = 0.033). Locally infected patients with delayed extraction (10.7 days) were associated with acute kidney injury (OR: 3.45; 95% CI: 1.11 to 10.77; p = 0.033) and respiratory failure (OR: 10.29; 95% CI: 1.26 to 83.93; p = 0.030). Delayed CIED extraction in both groups was associated with increased 1-year mortality.
Conclusions:
Delayed infected CIED extraction is associated with worse outcomes. This underscores the importance of early detection and a strategy for prompt management including lead extraction.
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