Transvenous Lead Extraction in Patients with Cardiac Implantable Device: The Impact of Systemic and Local Infection on Clinical Outcomes—An ESC-EHRA ELECTRa (European Lead Extraction Controlled) Registry Substudy
Igor Diemberger,
Luca Segreti,
Christopher A. Rinaldi,
Jesper Hastrup Svendsen,
Andrzej Kutarski,
Arwa Younis,
Cécile Laroche,
Christophe Leclercq,
Barbara Małecka,
Przemyslaw Mitkowski,
Maria Grazia Bongiorni,
On behalf of the ELECTRa Investigators
Affiliations
Igor Diemberger
Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
Luca Segreti
Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
Christopher A. Rinaldi
Cardiology Department, 6th Floor East Wing, Guy’s & St Thomas’ Hospitals, Westminster Bridge Rd, London SE1 7EH, UK
Jesper Hastrup Svendsen
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 1165 Copenhagen, Denmark
Andrzej Kutarski
Department of Cardiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
Arwa Younis
Heart Center/Sheba Medical Center Tel Hashome, Sackler School of Medicine Tel Aviv University, Tel Aviv 69978, Israel
Cécile Laroche
EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology (ESC), 2035 Route des Colles, Sophia Antipolis, 06903 Valbonne, France
Christophe Leclercq
Service de Cardiologie et Maladies Vasculaires CHU Pontchaillou, 2, Rue Henri le Guilloux, CEDEX 09, 35033 Rennes, France
Barbara Małecka
Department of Electrocardiology, The John Paul II Hospital Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
Przemyslaw Mitkowski
1st Department of Cardiology, Karol Marcinkowski University of Medical Sciences Head Electrotherapy Laboratory, University Hospital ul. Dluga 1/2, 61-848 Poznan, Poland
Maria Grazia Bongiorni
Cardiology Department, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
Background: Infections of cardiac implantable devices (CIEDI) have poor outcomes despite improvement in lead extraction (TLE) procedures. Methods: To explore the influence of CIEDI on the outcomes of TLE and the differences between patients with systemic (Sy) vs. local (Lo) CIEDI, we performed a sub-analysis of the EORP ELECTRa (European Lead Extraction ConTRolled) Registry. Results: Among 3555 patients enrolled by 73 centers in 19 Countries, the indication for TLE was CIEDI in 1850: 1170 with Lo-CIEDI and 680 with Sy-CIEDI. Patients with CIEDI had a worse in-hospital prognosis in terms of major complications (3.57% vs. 1.71%; p = 0.0007) and mortality (2.27% vs. 0.49%; p p = 0.0345). Patients with Sy-CIEDI more frequently had an initial CIED implant and a higher prevalence of comorbidities, while subjects with Lo-CIEDI had a higher prevalence of previous CIED procedures. Time from signs of CIEDI and TLE was longer for Lo-CIEDI despite a shorter pre-TLE antibiotic treatment. Conclusions: Patients with CIEDI have a worse in-hospital prognosis after TLE, especially for patients with Sy-CIEDI. These results raise the suspicion that in a relevant group of patients CIEDI can be systemic from the beginning without progression from Lo-CIEDI. Future research is needed to characterize this subgroup of patients.
