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Cardiac device-related infective endocarditis need for lead extraction whatever the device according to the ESC EORP

Erwan Donal1, Christophe Tribouilloy2, Anita Sadeghpour3

  • 1Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, hopital pontchaillou, 35000 Rennes, France.

European Heart Journal Open
|July 19, 2023
PubMed

Insights

Cardiac device-related infective endocarditis (CDRIE) management and prognosis are often poor, especially with left heart infective endocarditis (LHIE). Device extraction improves outcomes, even when the cardiac device appears uninfected.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Device Management

Background:

  • Cardiac device-related infective endocarditis (CDRIE) is a serious complication of cardiac device (CD) implantation.
  • Current management often involves antibiotics and device extraction, but real-world data on prognosis and specific patient groups are limited.

Purpose of the Study:

  • To investigate the characteristics, prognosis, and management of CDRIE in a large European cohort.
  • To compare outcomes in patients with isolated CDRIE, left heart infective endocarditis (LHIE) with an uninfected CD (LHIE+CDRIE-), and combined LHIE and CDRIE (LHIE+CDRIE+).

Main Methods:

  • Analysis of 483 patients from the EURO-ENDO registry.
  • Comparison of three groups: isolated CDRIE (n=280), LHIE+CDRIE- (n=157), and LHIE+CDRIE+ (n=46).
  • Assessment of in-hospital mortality, device extraction rates, and factors influencing prognosis using echocardiography and nuclear imaging.

Main Results:

  • In-hospital mortality was higher in LHIE+CDRIE- (22.3%) and LHIE+CDRIE+ (30.4%) compared to isolated CDRIE (13.2%).
  • Device extraction was performed in 62.1% of isolated CDRIE, 10.2% of LHIE+CDRIE-, and 45.7% of LHIE+CDRIE+ patients.
  • Device extraction was significantly associated with a better prognosis (HR 0.59), including in the LHIE+CDRIE- group (P=0.047).

Conclusions:

  • Prognosis for endocarditis in CD patients remains poor, particularly with concurrent LHIE.
  • Device extraction, though not always performed, is linked to improved survival.
  • Even in cases of LHIE with an apparently uninfected CD, device removal may offer survival benefits.
Abstract

Keywords:
Cardiac deviceImplantable defibrillatorInfective endocarditisPacemakerPrognosisstaphylococci

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