A Novel Approach to Identifying Appropriate Candidates for Transvenous Lead Extraction

Area of Science:

• Cardiology
• Infectious Diseases
• Health Informatics

Background:

• Cardiac implantable electronic device (CIED)-related infections necessitate transvenous lead extractions (TLEs), with rising incidence.
• Delayed TLE referrals in CIED infection cases are common and linked to increased patient mortality.
• Effective identification strategies are crucial for timely intervention.

Purpose of the Study:

• To evaluate a comprehensive strategy for managing CIED infections.
• To assess an electronic medical record (EMR)-based notification algorithm for identifying patients requiring TLE.
• To describe the clinical outcomes associated with this proactive approach.

Main Methods:

• An EMR-based notification algorithm alerted staff to inpatients with CIEDs receiving antibiotics or with positive blood cultures.
• High-risk patients were evaluated by electrophysiology specialists.
• Demographics, procedural data, and clinical outcomes were analyzed retrospectively.

Main Results:

• The algorithm generated 1829 notifications, leading to 39 consultations and 18 TLEs.
• Common pathogens included MSSA (56%) and MRSA (22%).
• Median time from review to TLE was 2 days; 67% survival was observed at 133-day follow-up.

Conclusions:

• An EMR-based notification algorithm effectively identifies patients with CIED infections suitable for TLE.
• This comprehensive approach facilitates timely TLEs, addressing a critical gap in care.
• Early detection and intervention are key to managing CIED-related infections.