Leadless Cardiac Pacemaker Implantation After Lead Extraction in Patients With Severe Device Infection.
Conventional pacemaker therapy is limited by short- and long-term complications, most notably device infection. Transcatheter pacing systems (TPS) may be beneficial in this kind of patients as they eliminate the need for a device pocket and leads and thus may reduce the risk of re-infection.



We assessed a novel procedure in 6 patients with severe device infection who were pacemaker dependent. After lead extraction a single chamber TPS was implanted into the right ventricle.



Of the 6 patients who underwent lead extraction due to severe device infection at our institution, 3 were diagnosed with a pocket infection only, whereas the other 3 showed symptoms of both pocket and lead infection. Successful lead extraction and TPS implantation was accomplished in all patients. Four patients were bridged with a temporary pacemaker between 2 hours and 2 days after lead extraction, whereas 2 patients had the TPS implanted during the same procedure just before traditional pacemaker system removal. All patients stayed free of infection during the follow-up period of 12 weeks. An additional positron emission tomography scan was performed in each patient and indicated no signs of an infection around the TPS.



Transcather pacemaker implantation was safe and feasible in 6 patients and did not result in re-infection even if implanted before removal of the infected pacemaker system within the same procedure. Therefore, implantation of a TPS may be an option for patients with severe device infection, especially in those with blocked venous access or who are pacemaker dependent.
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria. alexander.kypta@gmail.com.
Alexander
A
Kypta
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Hermann
H
Blessberger
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Juergen
J
Kammler
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Thomas
T
Lambert
Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria.
Michael
M
Lichtenauer
Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Walter
W
Brandstaetter
Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Michael
M
Gabriel
Department of Cardiology, Kepler University Hospital Linz, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria.
Clemens
C
Steinwender
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D020878:Device Removal; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
Micra; infection; lead extraction; leadless pacemaker; pacemaker lead