Nadeem Bilawal, Sedrakyan Surik, Fatima Amel, Baig Mirza Mehmood Ali, Ahmed Ali, Sherwani Mifrah Rahat Khan, Wylie John
Internal Medicine, Boston Medical Center, Boston, MA, USA.
Internal Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
J Interv Card Electrophysiol. 2024 Dec 5. doi: 10.1007/s10840-024-01960-2.
The optimal reimplantation strategies following the removal of infected cardiovascular implantable electronic devices (CIEDs) remain inadequately understood. Given the limitations and risks associated with traditional approaches, the investigation of alternative devices, such as leadless pacemakers (LPs), has gained attention due to their potentially lower infection risk.
We reviewed literature sources including PubMed, Scopus, and Embase, utilizing a combination of search terms. The inclusion criterion was leadless pacemaker (LP) implantation following lead removal (LR) of infected CIEDs, while the exclusion criterion was LR for noninfectious indications. Study endpoints encompassed patient outcomes during follow-up.
Our literature review yielded 827 articles, of which 22 met the inclusion criteria, encompassing a cohort of 657 patients who underwent LR followed by LP implantation. A total of 295 (44.9%) patients underwent concurrent LP implantation during the LR procedure. The rest underwent delayed procedures, and the overall duration between LR of infected CIED and LP implantation was 4.32 ± 3.9 days. A total of 194 (29.5%) patients had systemic CIED infections, whereas 153 (23.3%) had isolated pocket infections. In our patient cohort, procedural complications were scarce. Over a mean follow-up period of 13.3 ± 9.4 months, pacemaker syndrome was observed in 4 patients (0.61%), and 3 patients (0.46%) experienced persistent or recurrent infections.
Our review finds both concurrent and delayed LP implantation after infected CIED extraction to be safe, with low reinfection rates and minimal complications. LPs could also serve as a bridge to CRT re-implantation minimizing the use of temporary pacing systems.
感染性心血管植入式电子设备（CIED）移除后的最佳再植入策略仍未得到充分理解。鉴于传统方法的局限性和风险，对诸如无导线起搏器（LP）等替代设备的研究因潜在较低的感染风险而受到关注。
我们检索了包括PubMed、Scopus和Embase在内的文献来源，使用了多种检索词组合。纳入标准为感染性CIED导线移除（LR）后植入无导线起搏器（LP），排除标准为非感染性适应证的LR。研究终点包括随访期间的患者结局。
我们的文献综述共获得827篇文章，其中22篇符合纳入标准，涵盖657例接受LR后植入LP的患者队列。共有295例（44.9%）患者在LR手术期间同时植入LP。其余患者接受延迟手术，感染性CIED的LR与LP植入之间的总时长为4.32±3.9天。共有194例（29.5%）患者发生全身性CIED感染，而153例（23.3%）患者发生孤立性囊袋感染。在我们的患者队列中，手术并发症较少。在平均13.3±9.4个月的随访期内，4例患者（0.61%）出现起搏器综合征，3例患者（0.46%）发生持续性或复发性感染。
我们的综述发现，感染性CIED拔除后同时或延迟植入LP均安全，再感染率低且并发症极少。LP还可作为心脏再同步治疗（CRT）再植入的桥梁，减少临时起搏系统的使用。
