Lead Extraction for Treatment of Cardiac Device Infection: A 20-Year Single Centre Experience.
BACKGROUND
Infection is one of the most feared complications of cardiac implantable electronic devices. We report microbiology, antimicrobial therapy and infection recurrence in patients with cardiac device infection (CDI) treated with transvenous lead extraction (TLE) at a single centre over a 20-year period.


METHODS
We identified a cohort of consecutive patients undergoing TLE for CDI by a single operator at a single high volume centre. Retrospective analysis of patient characteristics, microbiology, outcomes and infection recurrence was performed.


RESULTS
Between May 1992 to March 2012, 348 patients underwent extraction due to localised or systemic infection. Seven hundred and twenty leads were extracted from these patients. The mean follow-up was 5.5+/-4.9 years. Staphylococcal species accounted for 81% of CDI. A difference is seen in infection onset for device revision compared with initial implants [median 10 months vs 24 months, P=0.0001]. Duration of antibiotics therapy depended on the nature of the CDI (21 days post TLE for systemic vs. 10 days for localised infection, P < 0.0001). There was comparable mortality in the 37 (11.2%) patients who did not have a replacement device compared with a replacement (30% vs 29%, P=0.9). Retained lead fragments are a risk factor for CDI recurrence (20.8% recurrence in retained fragments vs 4.3% in complete removal, P=0.006).


CONCLUSIONS
Cardiac device infection can be successfully treated with a combination of TLE and antibiotic therapy. Device therapy can be safely withdrawn in some patients. Retained lead fragments are a risk factor for recurrent CDI following extraction.
Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia. Electronic address: sgomes@med.usyd.edu.au.
Sean
S
Gomes
Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia.
Gregory
G
Cranney
Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.
Michael
M
Bennett
Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia.
Robert
R
Giles
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D005260:Female; D006353:Heart-Assist Devices / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality*; D013210:Staphylococcus
D000900:Anti-Bacterial Agents
Infection; Internal cardioverter-defibrillator; Lead extraction; Pacemaker