Endocardial versus epicardial pacing in pacemaker-dependent patients after device extraction: a meta-analysis

Area of Science:

• Cardiology
• Medical Devices
• Infectious Diseases

Background:

• Cardiac implantable electronic device (CIED) infections necessitate device extraction and temporary pacing solutions.
• Pacemaker-dependent patients require alternative pacing strategies during CIED reimplantation.
• Comparing temporary-pacemaker (TP) and epicardial-pacing-system (EPI) strategies is crucial for optimizing patient outcomes.

Approach:

• A meta-analysis was conducted on observational studies comparing TP and EPI strategies in pacemaker-dependent patients post-CIED extraction.
• Electronic databases were searched up to March 25, 2022, for relevant clinical outcomes.
• Three studies involving 339 patients (156 TP, 183 EPI) were included in the analysis.

Key Points:

• TP strategy significantly reduced the composite outcome of relevant complications (all-cause death, infections, revision/upgrading) compared to EPI (12.1% vs 28.9%).
• TP strategy also decreased the need for upgrading (0% vs 12%), reintervention on reimplanted CIED (1.9% vs 14.7%), and increased pacing threshold risk (0% vs 5.4%).
• A trend towards reduced all-cause death was observed with TP strategy (8.9% vs 14.2%), although TP was associated with a longer discharge time (9.60 days).

Conclusions:

• The temporary-pacemaker (TP) strategy is associated with a lower incidence of composite adverse outcomes, including death, complications, and reinterventions, compared to the epicardial-pacing-system (EPI) strategy.
• TP strategy effectively mitigates the need for reimplanted device upgrading and reduces the risk of increased pacing thresholds.
• While TP strategy demonstrates superior clinical outcomes, it necessitates a longer hospital discharge duration.