Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
J Cardiovasc Electrophysiol. 2022 Mar;33(3):464-470. doi: 10.1111/jce.15363. Epub 2022 Jan 31.
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.
心脏植入式电子设备（CIED）囊袋和全身感染仍然是传统 CIED 的常见并发症，与高发病率和死亡率相关。无导线起搏器可能是许多患者在完全去除 CIED 感染的硬件后进行起搏的一种有吸引力的替代方法，因为它可以消除与手术囊袋相关的并发症，并且降低复发并发症的风险。
描述在因感染而去除 CIED 系统后，使用无导线起搏器植入治疗 CIED 感染的方法和结果。
描述 2014 年 11 月 11 日至 2019 年 11 月 18 日期间，在杜克大学医院因 CIED 感染和设备取出后，行无导线起搏器植入术的患者的患者特征和术后结局。感兴趣的结局包括手术并发症、起搏器综合征、系统修订需要和再次感染。
在 39 例患者中，平均年龄为 71±17 岁，31%为女性，最常见的初始起搏指征为完全性心脏阻滞（64.1%），其中 9 例（23.1%）患者在植入 Micra 时依赖起搏器。在 CIED 感染中最常见的病原体是金黄色葡萄球菌（43.6%）。9 例患者在取出 CIED 当天或之前植入了无导线起搏器，其余 30 例患者在取出 CIED 后植入了无导线起搏器。在无导线起搏器植入后的随访（平均 24.8±14.7 个月）期间，共有 3 例主要并发症：1 例腹股沟血肿、1 例股动静脉瘘和 1 例起搏器综合征。在植入无导线起搏器后，无患者出现 CIED 感染复发的证据。
尽管存在先前的 CIED 感染和再次感染的风险增加，但在去除 CIED 系统后，植入无导线起搏器后平均随访超过 2 年，并未发现 CIED 感染的证据。需要进行更大规模、随访时间更长的研究，以确定在因 CIED 感染而去除 CIED 系统后，在永久性起搏之前的临时起搏期间，在有先前 CIED 感染的患者中，与传统起搏器相比，植入无导线起搏器是否具有长期优势。
