Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey.
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Cardiol. 2023 Sep 15;203:444-450. doi: 10.1016/j.amjcard.2023.07.071. Epub 2023 Aug 3.
The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIEDs) are not well-established. This study sought to describe the outcomes of LP implantation after TLR of infected CIED. We conducted a literature search using PubMed and Embase for a combination of terms including LP implantation, transvenous lead extraction, TLR, transvenous lead explant, infected CIED, infected pacemaker, and infected implantable cardioverter defibrillator. The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for noninfectious reasons. Study end points included procedural complications and LP infection during follow-up. Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 174 [69%] males) were included. The most common indication of the initial device implantations was a high-degree atrioventricular block (n = 100 of 253, 39.5%). Of the 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during the TLR procedure, and 36 patients (14.2%) had temporary transvenous pacing as a bridge from TLR to LP implantation. Of the 148 patients with data on the type of CIED infection, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus aureus was the most common causative organism in 33% of the reported patients. The LP was implanted an average of 5.4 ± 10.7 days after TLR of infected CIED. During the LP implantation, 1 patient (0.4%) had unsuccessful implantation because of an intraprocedural complication requiring sternotomy. After LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ± 10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. This study suggests that LP implant is feasible and safe after removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%. Large prospective studies are needed to better evaluate the best timing of LP implantation after TLR of an infected CIED.
经静脉导线移除（TLR）治疗感染性心脏植入式电子设备（CIED）后植入无导线起搏器（LP）的结果尚不清楚。本研究旨在描述 TLR 治疗感染性 CIED 后 LP 植入的结果。我们使用 PubMed 和 Embase 进行了文献检索，使用了包括 LP 植入、经静脉导线拔除、TLR、经静脉导线取出、感染性 CIED、感染性起搏器和感染性植入式心律转复除颤器等术语的组合。纳入标准是 TLR 治疗感染性 CIED 后植入 LP。排除标准是 TLR 用于非感染性原因。研究终点包括手术并发症和随访期间的 LP 感染。在回顾的 132 篇出版物中，有 13 项研究共纳入 253 例患者（74±14 岁，174 例[69%]为男性）。最初设备植入的最常见适应证是高度房室传导阻滞（n=253 例中的 100 例，39.5%）。在 253 例患者中，105 例（41.5%）在 TLR 过程中同时进行 LP 植入，36 例（14.2%）有临时经静脉起搏作为从 TLR 到 LP 植入的桥接。在 148 例有 CIED 感染类型数据的患者中，56.8%有全身 CIED 感染，43.2%有孤立的囊袋感染。金黄色葡萄球菌是报告患者中最常见的病原体，占 33%。LP 在 TLR 治疗感染性 CIED 后平均 5.4±10.7 天植入。在 LP 植入过程中，1 例（0.4%）患者因术中并发症需要开胸而植入不成功。LP 植入后，2 例（0.8%）发生腹股沟血肿，2 例（0.8%）发生股动静脉瘘，1 例（0.4%）发生需要心包穿刺的心包积液。在平均 11.3±10.6 个月的随访期间，3 例（1.2%）患者发生起搏器综合征，1 例（0.4%）患者发生慢性心力衰竭急性加重，仅 1 例（0.4%）患者发生 LP 相关性感染，需要取出 LP。本研究表明，在感染性 CIED 移除后植入 LP 是可行和安全的，累积不良事件发生率为 4%，再感染率为 0.4%。需要进行大型前瞻性研究以更好地评估 TLR 治疗感染性 CIED 后 LP 植入的最佳时机。
