Inoue Naoya, Ito Yuji, Imaizumi Takahiro, Morikawa Shuji, Murohara Toyoaki
Department of Cardiology Chutoen General Medical Center Kakegawa, Shizuoka Japan.
Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan.
J Arrhythm. 2024 Dec 26;41(1):e13208. doi: 10.1002/joa3.13208. eCollection 2025 Feb.
Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.
Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.
Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%-61.2%) and systemic infections at 46.3% (95% CI: 29.5%-64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%-28.3%, : 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%-13.5%, : 4%) for LP implantation after CIED extraction ( = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%-31.6%, : 0%) for simultaneous implantation and 8.71% (4.46%-16.3%, : 21%) after extraction ( = 0.008). Reinfection was not observed in any of these studies.
Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.
对于与心脏植入式电子设备（CIED）相关的感染，强烈建议移除CIED，且无导线起搏器（LP）越来越多地用于再植入。然而，因感染而在移除CIED后植入LP的最佳时机和安全性仍不明确。本系统评价和荟萃分析旨在评估在CIED移除的同时或之后进行LP植入时的并发症发生率（全因死亡率和再感染率）。
在PubMed、Cochrane图书馆和谷歌学术搜索2015年至2024年9月发表的研究。符合条件的是关于CIED移除和LP植入的观察性研究和病例系列。主要结局是LP植入后的全因死亡率和再感染率。使用弗里德曼-图基双反正弦变换获得合并估计值。使用MINORS标准评估研究质量，由两位作者进行数据提取和独立评估。
在396条记录中，16项研究纳入分析，共653例患者（平均年龄：76.9岁）。孤立性囊袋感染发生率为46.7%（95%CI：32.7%-61.2%），全身感染发生率为46.3%（95%CI：29.5%-64.0%）。CIED移除与LP植入同时进行时，主要结局发生率为19.4%（95%CI：12.8%-28.3%，I² = 0%），而在CIED移除后进行LP植入时为7.79%（4.37%-13.5%，I² = 4%）（P = 0.009）。同时植入时的全因死亡率为22.8%（95%CI：15.9%-31.6%，I² = 0%），移除后为8.71%（4.46%-16.3%，I² = 21%）（P = 0.008）。在这些研究中均未观察到再感染。
因感染而同时进行CIED移除和LP植入可能与全因死亡率增加的风险相关。
