Leadless pacemaker implantation after lead extraction for cardiac implanted electronic device infection.
cardiac implanted electronic device infection
extraction
leadless pacing
pacemaker
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
19
10
2021
received:
24
08
2021
accepted:
29
10
2021
pubmed:
15
1
2022
medline:
17
3
2022
entrez:
14
1
2022
Statut:
ppublish
Résumé
Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for many patients following complete hardware removal for a CIED infection by eliminating surgical pocket-related complications as well as lower risk of recurrent complications. To describe use and outcomes associated with leadless pacemaker implantation following extraction of a CIED system due to infection. Patient characteristics and postprocedural outcomes were described in patients who underwent leadless pacemaker implantation at Duke University Hospital between November 11, 2014 and November 18, 2019, following CIED infection and device extraction. Outcomes of interest included procedural complications, pacemaker syndrome, need for system revision, and recurrent infection. Among 39 patients, the mean age was 71 ± 17 years, 31% were women, and the most frequent primary pacing indication was complete heart block (64.1%) with 9 (23.1%) patients being pacemaker dependent at the time of Micra implantation. The primary organism implicated in the CIED infection was Staphylococcus aureus (43.6%). Nine of the 39 patients had a leadless pacemaker implanted before or on the same day as their extraction procedure, and the remaining 30 patients had a leadless pacemaker implanted after their extraction procedure. During follow-up (mean 24.8 ± 14.7 months) after leadless pacemaker implantation, there were a total of 3 major complications: 1 groin hematoma, 1 femoral arteriovenous fistula, and 1 case of pacemaker syndrome. No patients had evidence of recurrent CIED infection after leadless pacemaker implantation. Despite a prior CIED infection and an elevated risk of recurrent infection, there was no evidence of CIED infection with a mean follow up of over 2 years following leadless pacemaker implantation at or after CIED system removal. Larger studies with longer follow-up are required to determine if there is a long-term advantage to implanting a leadless pacemaker versus a traditional pacemaker following temporary pacing when needed during the periextraction period in patients with a prior CIED infection.
Sections du résumé
BACKGROUND
Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for many patients following complete hardware removal for a CIED infection by eliminating surgical pocket-related complications as well as lower risk of recurrent complications.
OBJECTIVE
To describe use and outcomes associated with leadless pacemaker implantation following extraction of a CIED system due to infection.
METHODS
Patient characteristics and postprocedural outcomes were described in patients who underwent leadless pacemaker implantation at Duke University Hospital between November 11, 2014 and November 18, 2019, following CIED infection and device extraction. Outcomes of interest included procedural complications, pacemaker syndrome, need for system revision, and recurrent infection.
RESULTS
Among 39 patients, the mean age was 71 ± 17 years, 31% were women, and the most frequent primary pacing indication was complete heart block (64.1%) with 9 (23.1%) patients being pacemaker dependent at the time of Micra implantation. The primary organism implicated in the CIED infection was Staphylococcus aureus (43.6%). Nine of the 39 patients had a leadless pacemaker implanted before or on the same day as their extraction procedure, and the remaining 30 patients had a leadless pacemaker implanted after their extraction procedure. During follow-up (mean 24.8 ± 14.7 months) after leadless pacemaker implantation, there were a total of 3 major complications: 1 groin hematoma, 1 femoral arteriovenous fistula, and 1 case of pacemaker syndrome. No patients had evidence of recurrent CIED infection after leadless pacemaker implantation.
CONCLUSIONS
Despite a prior CIED infection and an elevated risk of recurrent infection, there was no evidence of CIED infection with a mean follow up of over 2 years following leadless pacemaker implantation at or after CIED system removal. Larger studies with longer follow-up are required to determine if there is a long-term advantage to implanting a leadless pacemaker versus a traditional pacemaker following temporary pacing when needed during the periextraction period in patients with a prior CIED infection.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
464-470Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Tjong FVY, Reddy VY. Permanent leadless cardiac pacemaker therapy. Circulation. 2017;135(no. 15):1458-1470. doi:10.1161/circulationaha.116.025037
Kypta A, Blessberger H, Kammler J, et al. Leadless cardiac pacemaker implantation after lead extraction in patients with severe device infection. J Cardiovasc Electrophysiol. 2016;27(no. 9):1067-1071. doi:10.1111/jce.13030
Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14(no. 12):e503-e551. doi:10.1016/j.hrthm.2017.09.001
Boyle TA, Uslan DZ, Prutkin JM, et al. Reimplantation and repeat infection after cardiac-implantable electronic device infections: experience from the MEDIC (multicenter electrophysiologic device infection cohort) database. Circ Arrhythm Electrophysiol. 2017;10(3):e004822.
El-Chami MF, Al-Samadi F, Clementy N, et al. Updated performance of the micra transcatheter pacemaker in the real-world setting: a comparison to the investigational study and a transvenous historical control. Heart Rhythm. 2018;15(no. 12):1800-1807. doi:10.1016/j.hrthm.2018.08.005
El-Chami MF, Johansen JB, Zaidi A, et al. Leadless pacemaker implant in patients with pre-existing infections: results from the micra postapproval registry. J Cardiovasc Electrophysiol. 2019;30(no. 4):569-574. doi:10.1111/jce.13851
Beurskens NEG, Tjong FVY, Dasselaar KJ, Kuijt WJ, Wilde AAM, Knops RE. Leadless pacemaker implantation after explantation of infected conventional pacemaker systems: a viable solution?”. Heart Rhythm. 2019;16(no. 1):66-71. doi:10.1016/j.hrthm.2018.07.006
Gomes S, Cranney G, Bennett M, Giles R. Lead extraction for treatment of cardiac device infection: a 20-year single centre experience. Heart, Lung Circ. 2017;26(no. 3):240-245. doi:10.1016/j.hlc.2016.06.1217
Saeed O, Gupta A, Gross JN, Palma EC. Rate of cardiovascular implantable electronic device (CIED) re-extraction after recurrent infection. Pacing Clin Electrophysiol. 2014;37(no. 8):963-968. doi:10.1111/pace.12407
El-Chami MF, Mayotte J, Bonner M, Holbrook R, Stromberg K, Sohail MR. Reduced bacterial adhesion with parylene coating: potential implications for micra transcatheter pacemakers. J Cardiovasc Electrophysiol. 2020;31(no. 3):712-717. doi:10.1111/jce.14362
Piccini JP, et al. Comparison of outcomes among patients implanted with a tined leadless versus transvenous single-chamber ventricular pacemaker in the novel Micra CED study. Presented on: May 8, 2020. HRS 2020.
Chang D, Gabriels JK, Soo Kim B, et al. Concomitant leadless pacemaker implantation and lead extraction during an active infection. J Cardiovasc Electrophysiol. 2020;31(no. 4):860-867. doi:10.1111/jce.14390
Gonzales H, Richardson T, Montgomery J, Crossley G, Ellis C. Comparison of leadless pacing and temporary externalized pacing following cardiac implanted device extraction. J Innov Card Rhythm Manag. 2019;10(no. 12):3930-3936. doi:10.19102/icrm.2019.101204