From Diagnosis of Cardiac Device Infection to Complete Extraction of the System

Abstract

Cardiac implantable electronic device (CIED) infection includes a broad range of clinical presentation from localized pocket infection to bacteremia with or without endocarditis. Long-term mortality varies between diagnostic subgroups, but higher rates are reported for systemic infections. If any form of CIED infection (CIEDI) is diagnosed, complete removal of the system is recommended to avoid recurrence of infection. Currently CIEDI is the most common indication for lead extraction. Considering the inherent risk of an open surgical procedure, transvenous lead extraction has become the preferred method; however, system removal is not without risk. Procedural complexity may vary significantly according to lead type, time from implant, and other features. Therefore, it is recommended that transvenous lead extraction be performed in centers with a sufficient procedural volume to allow surgical team members to maintain a high skill level. These centers also must be able to provide immediate cardiothoracic surgery backup in case of emergency thoracotomy or sternotomy. Several extraction tools and approaches are available that allow safe and successful transvenous CIED lead extraction without universal agreement on how to perform the procedures.