Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices

Background Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early...

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Published in:Journal of interventional cardiac electrophysiology 2023-09, Vol.66 (6), p.1477-1485
Main Authors: Breeman, Karel T. N., Beurskens, Niek E. G., Driessen, Antoine H. G., Wilde, Arthur A. M., Tjong, Fleur V. Y., Knops, Reinoud E.
Format: Article
Language:English
Subjects:
Cardiology
Disseminated infection
Echocardiography
Electronic equipment
Endocarditis
Health risks
Heart
Implantation
Infections
Medicine
Medicine & Public Health
Morbidity
Pacemakers
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Summary:Background Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers. Methods We included all patients with LP implantation as a replacement for an infected CIED, between January 2013 and December 2021. The occurrence of reinfection was assessed during standard follow-up visits. Results Twenty-nine patients (mean age 81 ± 9 years) were included, of which 21 (73%) had a pocket infection, 7 (24%) endocarditis, and 1 (3%) a systemic infection without endocarditis. All LP implantations were successful. LPs were implanted before extraction ( n  = 4, 13%), simultaneously with extraction ( n  = 5, 17%) and after extraction ( n  = 20, 70%). No reinfection occurred during the follow-up of median 32 months (IQR 13–66 months). Repeat blood cultures obtained in 9 (30%) patients and transthoracic echocardiography in all 7 patients with pacemaker endocarditis were negative for reinfection. In a subset of 6 LPs extracted during follow-up due to early battery depletion, prophylactically after the battery advisory or due to non-capture (median 36 months (range 0–67 months) post-implantation), histopathologic examination of tissues around the LPs showed no signs of infection. Conclusions After replacing infected CIEDs for an LP, no reinfections occurred in over 2.5 years follow-up. These results confirm that in case of CIED infection, the LP is an appealing replacement device. LP implantation before CIED extraction is feasible.
ISSN:1572-8595
1383-875X
1572-8595
DOI:10.1007/s10840-022-01457-w