title: Comparison of delayed transvenous reimplantation and immediate surgical epicardial approach in pacing-dependent patients undergoing extraction of infected permanent pacemakers.
abstract: BACKGROUND
  Pacemaker infection in pacing-dependent patients is challenging. After extraction, temporary pacing usually is utilized before delayed reimplantation (after an appropriate course of antibiotics), resulting in prolonged hospital stays. A single combined procedure of epicardial (EPI) pacemaker implantation and system extraction may prevent this.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the feasibility and safety of these 2 approaches by comparing clinical outcome for both strategies over 1 year.
  
  
  METHODS
  In center 1, 80 consecutive pacemaker-dependent patients underwent extraction with an externalized pacemaker and delayed implantation on the contralateral side (ENDO group). In center 2, 80 consecutive patients had 2 epicardial ventricular leads surgically implanted with extraction of the infected pacemaker during the same procedure (EPI group). Patients were followed-up for 12 months.
  
  
  RESULTS
  One hundred sixty pacing-dependent patients were successfully implanted and extracted (ENDO group 71 ± 13 years vs EPI group 73 ± 14, P = NS). In the EPI group, 2 patients developed significant pericardial bleeding. In-hospital mortality was 0% in the ENDO group and 2.5% in the EPI group. Total hospitalization time was 15 ± 7 days in the ENDO group vs 9 ± 6 days in the EPI group (P <.001). At 1 year, no infection recurrences occurred in either group, and mortality was equal (5% in each group). Median 1-year pacing thresholds were lower in the ENDO vs the EPI group (0.8 ± 0.6 V vs 1.1 ± 0.6 V, P = .02).
  
  
  CONCLUSIONS
  The ENDO and EPI strategies had an excellent success rate and low risk of complications. A single procedure using surgical epicardial lead implantation was associated with a shorter duration of hospital stay.
authors.affiliation: Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France. Electronic address: sana.amraoui@hotmail.com.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Li
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Williams
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Scully
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Claridge
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Behar
authors.affiliation: Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
authors.affiliation: Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D000368:Aged; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010496:Pericardium; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome
keywords: Endocardial reimplantation; Epicardial reimplantation; Extraction; Pacemaker infection; Pacing-dependent patients