Is there an optimal timing for device reimplantation after lead extraction due to CIED infection?

Complete cardiovascular implantable electronic devices (CIED) removal is recommended for all patients (P) with confirmed CIED infection, regardless of whether there is definite evidence of device involvement. However, when considering device reimplantation, optimal timing following transvenous lead removal remains unclear.

Our study aimed to evaluate the short and long term effects of different device reimplantation times in P that underwent CIED removal due to infection.

Prospective single-centre study in P that underwent lead extraction due to CIED infection and in whom device reimplantation was performed. P were divided into three groups, according to timing of device reimplantation: Group A (reimplantation in <72h), Group B (reimplantation in 72h-2 weeks), and Group C (reimplantation in >2 weeks).

Follow-up of the three groups was performed in the short-term - regarding the need for urgent surgical intervention or death/complications/reintervention during hospitalization - and long-term – one-year mortality or rehospitalisation.

From a total of 257 P, CIED infection was present in 205 P (80%). 116 P (57%) underwent device reimplantation, which performed in the same hospitalization in 110 P. 160 P (78%) were male, median age was 75 (IQR 62-82) years, median dwell time of the leads was 84 (IQR 36-132) months. In 55% of the cases there was pocket infection only, 66 P (32%) had positive blood cultures, 39 P (19%) were under targeted antibiotic therapy and 80 P (39%) had positive cultures from the procedure. Regarding the CIED that underwent extraction, 47% were pacemakers (8% VVI, 8% VDD and 31% DDD), 6% were ICD and 11% were CRT – median number of electrodes was 2 (IQR 1-2). Median time to reimplantation after device removal in patients with positive blood cultures was 5 (IQR 2-7) days. Regarding device reimplantation, there were 38 P (19%) in group A, 60 P (29%) in group B and 18 P (9%) in Group C. Differences between the three groups in terms of blood cultures, targeted antibiotic therapy and pre and post-device removal duration of antibiotic therapy are shown in table 1.

Median follow-up time was 26 (IQR 13-54) months. The differences between the three groups regarding short and long-term follow-up are shown in table 2.

In our study distinct timings of device reimplantation after CIED extraction due to infection did not show differences regarding short or long-term follow-up.Table 1  Table 2