Schvartz Noemi, Haidary Arian, Wakili Reza, Hecker Florian, Kupusovic Jana, Zsigmond Elod-Janos, Miklos Marton, Saghy Laszlo, Szili-Torok Tamas, Erath Julia W, Vamos Mate
Cardiology Center/Cardiac Electrophysiology Division, Internal Medicine Clinic, University of Szeged, 6725 Szeged, Hungary.
Department of Cardiology, Division of Clinical Electrophysiology, Goethe University Hospital Frankfurt, 60596 Frankfurt am Main, Germany.
J Cardiovasc Dev Dis. 2024 Apr 9;11(4):117. doi: 10.3390/jcdd11040117.
(1) Background: Early reintervention increases the risk of infection of cardiac implantable electronic devices (CIEDs). Some operators therefore delay lead repositioning in the case of dislocation by weeks; however, there is no evidence to support this practice. The aim of our study was to evaluate the impact of the timing of reoperation on infection risk. (2) Methods: The data from consecutive patients undergoing lead repositioning in two European referral centers were retrospectively analyzed. The odds ratio (OR) of CIED infection in the first year was compared among patients undergoing early (≤1 week) vs. delayed (>1 week to 1 year) reoperation. (3) Results: Out of 249 patients requiring CIED reintervention, 85 patients (34%) underwent an early (median 2 days) and 164 (66%) underwent a delayed lead revision (median 53 days). A total of nine (3.6%) wound/device infections were identified. The risk of infection was numerically lower in the early (1.2%) vs. delayed (4.9%) intervention group yielding no statistically significant difference, even after adjustment for typical risk factors for CIED infection (adjusted OR = 0.264, 95% CI 0.032-2.179, = 0.216). System explantation/extraction was necessary in seven cases, all being revised in the delayed group. (4) Conclusions: In this bicentric, international study, delayed lead repositioning did not reduce the risk of CIED infection.
(1) 背景：早期再次干预会增加心脏植入式电子设备（CIED）感染的风险。因此，一些操作人员在导线脱位的情况下会将导线重新定位推迟数周；然而，没有证据支持这种做法。我们研究的目的是评估再次手术时机对感染风险的影响。(2) 方法：对两个欧洲转诊中心连续接受导线重新定位的患者数据进行回顾性分析。比较早期（≤1周）与延迟（>1周至1年）再次手术患者第一年CIED感染的比值比（OR）。(3) 结果：在249例需要CIED再次干预的患者中，85例（34%）接受了早期（中位时间2天）再次手术，164例（66%）接受了延迟导线修复（中位时间53天）。共发现9例（3.6%）伤口/设备感染。早期（1.2%）干预组的感染风险在数值上低于延迟（4.9%）干预组，即使在对CIED感染的典型风险因素进行调整后，差异也无统计学意义（调整后的OR = 0.264，95%CI 0.032 - 2.179，P = 0.216）。7例需要进行系统取出/拔除，均在延迟组进行了修复。(4) 结论：在这项双中心的国际研究中，延迟导线重新定位并未降低CIED感染的风险。
