Temporal Trends in Utilization of Transvenous Lead Extractions Among Cardiac Implantable Electronic Device Infections

Cardiac implantable electronic device (CIED) infections are a growing concern, leading to significant morbidity and mortality. International guidelines recommend complete device and lead extraction for infected cases, yet real-world adherence to these recommendations remains suboptimal. The use of transvenous lead extraction (TLE) in Japan has not been well characterized.

This study aimed to investigate the real-world use of TLE in CIED infections, assess trends over time, and identify factors associated with the likelihood of undergoing TLE and the procedural complications.

This was a retrospective observational study using the Japanese Registry of All Cardiac and Vascular Diseases diagnosis procedure combination/per diem payment system (JROAD-DPC) from 2015 to 2021. Patients with a diagnosis of CIED infections were identified on the basis of the International Classification of Diseases, 10th revision codes.

Among 7,434 hospitalization records, only 38% underwent TLE for CIED infections in the overall hospitals. However, the use of TLE in certified TLE hospitals increased significantly from 54.0% in 2015 to 70.8% in 2021 (P trend <0.001). Independent predictors of reduced TLE use included a lower body mass index, female sex, cerebrovascular disease, and dementia. Notably, 65.5% of patients in noncertified hospitals were discharged home, a finding suggesting potential undertreatment.

Although the TLE rate is increasing, many patients with CIED infections do not undergo TLE. Addressing barriers through physician education, improved referral systems, and adherence to guideline-directed management, especially in noncertified hospitals, is essential for optimizing the TLE rate.