Cardiac Implantable Electronic Device Infections in Patients with Left Ventricular Assist Devices

Abstract

Cardiac implantable electronic device infections (CIED) reflect life threatening complication for LVAD patients. Despite antibiotic treatment removal or exchange of all foreign surfaces may be required for cure. However, there is limited published data and we here present to our knowledge the largest case series of CIED removal in LVAD patients. Since 2011, 161 patients underwent LVAD Implantation at our institution. We identified 7 patients who underwent infection related CIED removal and report outcome. Patient and infection characteristics, management strategy, and clinical outcomes are described. Of the 7 patients one was female; mean age was 54 years (range 42-64). Three of 7 patients had an ischemic cardiomyopathy, and 2 of 7 patients had a continuous flow LVAD placed as destination therapy. All patients presented with clinical signs of infection, lead-related endocarditis and vegetations. In one patient additional pocket infection was present. Causative pathogens included staphylococcus aureus (1), staphylococcus epidermidis (1), enterococcus faecalis (1), candida albicans (2), and culture negative (2). All patients underwent laser assisted complete CIED removal along with antimicrobial therapy. The mean implanted age of the removed leads was 5 years (2-10 years), and 3 of the 7 patients experienced a procedural complication (pocket hematoma) from CIED removal. Infection was successfully treated in all patients, except one. No re-occurrence of endocarditis was observed and no LVAD exchange was needed. One patient died within 30 days after CIED explantation due to multi organ failure and persistent sepsis. Five patients remained alive at latest follow-up with a median duration of 15 months (0.1-55 months) from the time of CIED explantation. Complete CIED removal combined with optimal antimicrobial therapy may be an effective and safe therapy for CIED infections in LVAD patients.