Abstract 14140: Management and Outcomes of Bacteremia After Transvenous Lead Extraction Complicated by Retained Lead Fragments

Abstract

Introduction: Complete hardware removal is indicated for cardiovascular implanted electronic devices (CIED) infection. While transvenous lead extraction (TLE) is often successful in removing the entire device, some patients are left with residual hardware due to lead breakdown or unsuccessful attempts at removal. We sought to assess the outcomes and management in patients with retained CIED components that can be a nidus for ongoing infection. Methods: Single center retrospective case series among patients with lead extraction between 2010 and 2022. Results: There were 9 of 930 TLE patients (1%) who met study criteria (age 68 ± 23 yrs, 78% men, 67% ICD, 44% CRT, oldest lead 10.1 yrs IQR 6.1-22.2, combined lead age 21.2 yrs IQR 14.7-54.9). Two patients (22%) had epicardial leads as well. The majority of patients (n=8/9, 89%) had systemic infection, including lead vegetations in 22% (n=2). The most common infection organism was Staphylococcus aureus (n=5, 56%). Residual CIED components included lead tips (n=4, 44%), epicardial leads (n=2, 22%), entire intravascular lead portion (n=2, 22%), and a remnant ICD coil remaining in the SVC (n=1, 11%). TLE attempt was halted in 1 patient with a right atrial perforation during extraction (only removed 4/6 leads) and another patient with unsuccessful removal via laser, mechanical, and snaring attempts. Device reimplantation was performed in 4 patients (44%). The patient with the RA perforation underwent reimplantation of an epicardial system at the time of repair. Median follow-up was 0.9 years (IQR 0.4-7.2). Three patients (33%) were managed with indefinite antibiotic suppression, while the median antibiotic duration for the remainder was 35 days (IQR 14-43). Two patients (22%) had recurrent infections, both of which occurred despite the use of indefinite antibiotic suppression. None of the patients with residual lead tip alone had subsequent infections or were managed with suppressive antibiotics. Conclusion: Recurrent infection can be problematic when retained lead components are present after TLE and occurred despite the use of indefinite suppressive antibiotics in some patients. Further investigation is necessary to determine if the risk of recurrent infection varies by the type of residual CIED components.