title: Clinical Outcomes of Patients with HIV Undergoing Lead Extraction for Infectious and Noninfectious Indications.
abstract: BACKGROUND
  With the increasing prevalence of human immunodeficiency virus positive (HIV+) patients in the United States, and the association between HIV and cardiovascular morbidity and mortality, the use of cardiac implantable electronic devices (CIEDs) in patients with HIV has become more common. With the increasing incidence of device-related complications, lead extraction is becoming a topic of importance in this population. As the use of implantable devices increases in the HIV+ population, complications are to be expected; therefore, lead extraction in the HIV population must be addressed.
  
  
  METHODS
  From January 2004 to May 2013, 1,018 patients requiring lead extraction were referred to a single, high-volume tertiary cardiovascular center. Within this group of patients, 10 were HIV+. We retrospectively reviewed the charts of this cohort and reported clinical variables of interest.
  
  
  RESULTS
  Infection was the most common indication for lead extraction and device removal. Four patients were in advanced heart failure, and the overall average ejection fraction of the sample population was 32.7 ± 16.3%. In addition, the majority of patients had one or more medical comorbidities. Devices removed, in order of frequency, were implantable cardioverter defibrillators, permanent pacemakers, and cardiac resynchronization therapy devices. On average, 35.6 ± 41.6 months elapsed from implantation of the oldest lead to the date of extraction. There were no major or minor complications and all procedures were clinically successful.
  
  
  CONCLUSIONS
  Laser lead extraction is both safe and effective in patients with HIV. This study sets a level of clinical precedent regarding the management of CIED infection or malfunction in patients with HIV.
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cohen
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Alayn
authors.initials: A
authors.lastname: Govea
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.|Department of Cardiothoracic Surgery, University of Miami Hospital, Miami, Florida.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
mesh_terms: D058409:Cardiac Resynchronization Therapy Devices; D020878:Device Removal; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cardiac device infection; cardiac implantable electronic device complications; cardiac implantable electronic device removal; laser sheath; transvenous lead extraction