Abstract
Introduction: Infection is a serious complication in patients with cardiac implantable electronic devices (CIEDs). Infection of the generator pocket, systemic bacteremia and lead-related or suspected endocarditis are absolute indications for device removal. While previous studies have reported infection as a major risk factor for mortality, it is unclear what proportion is related to complications of infection or the CIED lead removal procedure itself. Objective: We have conducted a systematic review looking at all-cause in-hospital mortality, intraprocedural, and procedure-related mortality in CIED lead removals and have done a subanalysis specifically exploring removals for infectious indications. Methods: A search was performed of studies published between January 1, 2000-August 29, 2019 indexed on Medline, EMBASE and Cochrane. Inclusion criteria were: (a) transvenous removal of ICD, pacemaker or CRT device leads, (b) Age≥18, (c) n>100 patients. Exclusion criteria were: (a) generator only procedures, (b) planned surgical extractions, (c) data prior to 2000. From these studies, we further selected papers containing mortality data in which all subjects had infectious indications for removal, or papers with infectious only cohorts of n>100 with mortality data. Outcomes: All-cause mortality during index hospitalization, intraprocedural mortality, procedure related mortality. Results: 2307 abstracts were screened after de-duplication resulting in 164 papers for full text review. Of these 164, 8 papers were selected for analysis based on our inclusion criteria. 7 reported periprocedural/mortality during index hospitalization which ranged from 1.47-7.20%; median 4.98% (IQR 2.74-5.69%). 4 studies reported intraprocedural mortality which ranged from 0-0.69%; median 0.10% (IQR 0.00-0.32%). and 6 reported procedure related death which ranged from 0-0.72%; median 0.50% (IQR 0.10-0.67%). Conclusions: Mortality after CIED lead removal is high in patients presenting with infection, however intraprocedural mortality and death directly related to the removal procedure remains low.
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