Safety and efficacy of transvenous lead removal after cardiovascular implantable electronic device infection in the older patients: A retrospective cohort study (english version)

Abstract

Background: Cardiovascular implantable electronic device (CIED) infection is a life-threatening complication following pacemaker therapy. Complete CIED removal is the first-line therapy for patients with CIED system infection. However, the safety and efficacy of transvenous lead removal of infected CIED in older patients (≥75 years of age) are unknown. Thus, our study aimed to investigate the safety and efficacy of transvenous lead removal of infected CIED in older patients. Subjects and Methods: This is a single-center retrospective cohort study in which 316 patients with transvenous lead removal after CIED infections were recruited from Nanjing Drum Tower Hospital between January 2013 and October 2019. We evaluated the safety of the CIED removal based on the rate of major complications (e.g., lead perforation, coronary sinus tear, and pericardial tamponade) and minor complications (e.g., minor pericardial effusion, venous thrombus, and minor hematoma). Procedural success rate and infection recurrence were used to evaluate the efficacy. The differences in gender, comorbidities, type of implanted devices, number and type of leads, anesthesia method, extraction strategies, complications, and complete removal rate were also analyzed. The study was approved by the Ethics Committee of Drum Tower Hospital, Nanjing University Medical School (approval No. 2019-230-01) on February 1, 2019. Results: In total, 316 patients were included, of whom 115 patients were ≥75 years old, and 79 were male. There were more defibrillation devices in the <75-year-old group (10.9% vs. 4.3%, P = 0.044). Seven cases (6.1%, 7/115) in the ≥75-year-old group had minor complications without major complications, whereas ten cases (5.0%, 10/201, P = 0.796) of <75-year-old group had minor complications with one case had major complications. 111 patients (96.5%, 111/115) in the ≥75-year-old group had complete removal of the pacing system. Four patients (3.5%, 4/115) achieved clinical success without removal failure. 191 patients (95.0%, 191/201, P = 0.933) in the <75-year-old group had complete removal of the pacing system, and nine patients (4.5%, 9/201, P = 0.776) had clinical success with 1 case (0.5%, 1/201) being failed to remove pacing system. Overall, there was no significant difference in the safety and efficacy among the two groups. Conclusions: Transvenous lead removal is safe and curative in patients ≥75 years old with CIED infections.