Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York.
Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York.
Heart Rhythm. 2023 Jun;20(6):853-860. doi: 10.1016/j.hrthm.2023.02.003. Epub 2023 Feb 9.
The rate of transvenous lead extraction (TLE) due to cardiac implantable electronic device (CIED) infection continues to rise. CIED infections are associated with significant morbidity and mortality. Temporary pacing in patients with active CIED infections after TLE can be challenging. Leadless pacing has emerged as an alternative approach in this patient population.
The purpose of this study was to describe the outcomes of a strategy using concomitant leadless pacemaker implantation and TLE in patients with active infections and ongoing pacing requirements.
This study involved all leadless pacemaker implantation procedures performed during TLE between June 2018 and September 2022 in the setting of active infection. Demographic characteristics, procedural details, and clinical outcomes were analyzed.
The study included 86 patients with indications for ongoing pacing, 60 (70%) men with mean age 77.4 ± 10.5 years, who underwent TLE and concomitant leadless pacemaker implantation in the setting of active infection. There were no procedure-related complications. Sixty-five patients (76%) had evidence of bacteremia, 80% of whom were discharged to complete their antimicrobial treatment. During a median follow-up of 163 days (interquartile range 57-403 days), there were no recurrent infections. Of the 25 deaths (29%) during the study period, 22 (88%) were unrelated to the initial infection. Nine deceased patients (36%) had methicillin-resistant Staphylococcus aureus or Candida infections, 3 of whom had persistent infection despite TLE.
Leadless pacing is a safe and efficacious approach for the management of patients with pacing requirements that undergo CIED extraction in the setting of active infection.
由于心脏植入式电子设备 (CIED) 感染，经静脉导线拔除 (TLE) 的比例持续上升。CIED 感染与显著的发病率和死亡率相关。在 TLE 后有活动性 CIED 感染的患者中进行临时起搏可能具有挑战性。在这种患者人群中，无导线起搏已成为一种替代方法。
本研究旨在描述在活动性感染和持续起搏需求的患者中，同时进行无导线起搏器植入和 TLE 的策略的结果。
这项研究包括 2018 年 6 月至 2022 年 9 月期间在活动性感染背景下进行的所有无导线起搏器植入手术。分析了人口统计学特征、手术细节和临床结果。
该研究包括 86 例有持续起搏指征的患者，60 例（70%）为男性，平均年龄 77.4 ± 10.5 岁，他们在活动性感染的情况下接受了 TLE 和同时进行的无导线起搏器植入。无手术相关并发症。65 例患者（76%）有菌血症证据，其中 80%出院完成其抗菌治疗。在中位随访 163 天（四分位距 57-403 天）期间，没有再次发生感染。在研究期间，25 例死亡（29%）中，22 例（88%）与初始感染无关。9 例死亡患者（36%）患有耐甲氧西林金黄色葡萄球菌或念珠菌感染，其中 3 例尽管进行了 TLE，但仍存在持续性感染。
在活动性感染背景下进行 CIED 拔除的起搏需求患者中，无导线起搏是一种安全有效的管理方法。
