Leadless pacemakers as replacement for infected transvenous pacemakers: different strategies are feasible

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pacemaker infections have a high morbidity and mortality and are an indication for extraction. For reimplantation, leadless pacemakers (LPs) may be preferable due to a low chance of infection. Even more, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers. Methods We included all patients with LP implantation before, simultaneously with, or after transvenous pacemaker extraction due to infection, between January 2013 and December 2021. Outcomes were assessed during standard follow-up visits. Results 30 patients (mean age 81±8 years) were included, of which 19 (63%) had a pocket infection, 10 (33%) endocarditis and 1 (3%) a systemic infection without endocarditis (Table). LP implantation was successful in all and was performed before extraction in 2 patients (7%; 3 and 5 days before), simultaneously in 6 (20%) and after extraction in 22 (73%). There were 3 procedural complications: 2 femoral artery bleedings and one LP dislocation. Also, one patient with complete AV block and an initially stable escape rhythm had an in-hospital cardiac arrest due to asystole after transvenous pacemaker extraction, but before LP implantation. During follow-up of median 21 months (IQR 7-53 months), no reinfection occurred. Six Nanostims were extracted due to early battery depletion, prophylactically after the battery advisory, or due to non-capture (median 36 months [range 0-67 months] after implantation); histopathologic examination of tissues around the devices showed no signs of infection. Two Nanostims were abandoned after which another device was implanted. No further device revisions were necessary during follow-up. Conclusions In case of transvenous pacemaker infection, LP implantation before, simultaneously with or after extraction is safe and effective.