Bridge pacemaker with an externalized active fixation lead for pacemaker-dependent patients with device infection.

Abstract

The risk of Cardiac Implantable Electronic Device (CIED) infection has been increasing in recent years. For pacemaker-dependent patients, a temporary pacemaker is needed before a new device can be implanted. The aim of this study is to evaluate the safety and efficacy of using a temporary pacing device with an externalized active fixation lead (bridge pacemaker) before a new device can be implanted in pacemaker-dependent patients with device infection. All patients who were admitted to our cardiac center with CIED infection and in need of bridge pacemaker implantation from April 2013 to August 2020 were prospectively enrolled in this observational study. The medical records of all patients were collected and evaluated. All procedure-related complications were also collected. Long-term outcomes, including reinfection and death within 1 year after hospital discharge, were collected through telephone follow-ups. During the study period, 1050 patients underwent CIED extraction, of which 312 pacemaker-dependent patients underwent bridge pacemaker implantation. The mean age of the extracted leads was 44 ± 38.7 months. The bridge pacemakers were in use for a mean duration of 6 days. Nine patients developed procedure-related complications including pericardial tamponade, pneumothorax, peripheral venous thrombosis, and pulmonary embolism. Three patients developed complications that were related to their bridge pacemakers, including lead dislodgement, over-sensing and elevated pacing threshold. During the 1-year follow-up, it was found that four patients had developed CIED reinfection and three patients had died due to cardiac-related reasons. A bridge pacemaker with an externalized active fixation lead is safe and efficacious for pacemaker-dependent patients with device infection.