Infection remediation after septic device extractions - comparison of
three treatment strategies including a one-year follow-up
Abstract
Introduction: Treating patients with CIED infections is often
challenging. In general, the infected device, including all leads, needs
to be completely removed before a new CIED can be implanted. Especially
in pacemaker-dependent patients, it is often impossible to have a
device-free interval to treat the infection. In those cases, the
question remains when to implant a new CIED and which bridging strategy
to use. Methods: In this single-center retrospective analysis,
we included 190 patients who received a complete CIED system extraction
between 2013 and 2019 due to device-related infection. We compared three
different treatment algorithms. Group 1 (SR) included 89 patients who
received system removal only (and delayed re-implantation). Group 2 (EL)
consisted of 28 patients who were treated with lead extraction and
simultaneous epicardial lead implantation, while the 78 patients in
Group 3 (SI) received lead removal with simultaneous contralateral
implantation of a new device. We retrospectively analyzed the peri- and
postoperative course and one-year follow-up. Results: Patients
in the SR and EL groups were significantly older, had more comorbidities
and a higher percentage of systemic infection compared to the SI group.
We found a comparable high number of successful infection treatments in
all groups, with complete lead removal in 95.5%, 96.4%, and 93.2% for
the SR, EL, and SI groups, respectively. Lead vegetations were removed
in 97.7%, 94.1%, and 100%. Device re-implantation was 100% in the EL
and SI groups, whereas in the SR group, only 49.4% of patients received
a device re-implantation. At one-year follow-up, the percentage of
freedom from infection and pocket irritation was comparable between
groups (94.7% SR and EL, 100% SI). We observed no procedure-related
mortality, while one-year mortality was 3.4% in the SR, 21.4% in the
EL and 4.1% in the SI group. Conclusion: We found comparable
success rates regarding device removal, successful infection treatment
and perioperative course between groups. However, most likely due to the
sicker patient collective with a high number of systemic infections, the
one-year mortality was significantly higher in the EL group. Treatment
algorithm should be selected due to type, severity, location of
infection and comorbidities of the patients.