Cardiac implantable electronic device (CIED)-associated infections are associated with higher morbidity, mortality and costs, however few patients are recommended for transvenous lead extraction (TLE) in spite of national and European recommendations and low rates of procedural complications at experienced centers.
A study published in the Journal of the American College of Cardiology reviewed over 25,000 admissions in the Nationwide Readmission Database between 2016-2019. Sciria, CT, et al found that only 11.5% were managed with a lead extraction (noted the rates rose from 7.6% to 14.5% from 2016-2019), even with low procedural complications.
In an accompanying editorial, Hussein AA, et al, state these findings should be a “call to arms” for clinicians to take action. They note it is clear from this report as well as prior publications that CIED infections increase mortality and morbidity, and the need for lead extraction (TLE) is well documented. The authors recognize the barriers for TLE due to the need for hybrid operating rooms, cardiac surgeon back up and experienced lead extraction physicians in this challenging climate. However, it is imperative that health care providers recognize CIED infections and refer to experienced clinicians for TLE evaluation and extraction as appropriate.
Articles: Sources of Information
Sciria CT, et al “Low utilization of lead extraction among patients with infective endocarditis and implanted cardiac electronic devices” J Am Coll Cardiol 2023; DOI: 10.1016/j.jacc.2023.02.042.
Hussein AA, et al “Cardiac implantable electronic devices and infective endocarditis: a call to arms…” J Am Coll Cardiol 2023; DOI: 10.1016/j.jacc.2023.02.043.
Guidelines
Blomström-Lundqvist C, Traykov V, Erba PA, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;41:2012-2032. https://doi.org/10.1093/ eurheartj/ehaa010
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77(4):e25–e197. https://www.sciencedirect.com/science/article/pii/S0735109720377962
Additional News Stories
Transvenous Lead Extraction Procedure in CIED and Endocarditis Patients Is Low Despite Low Complication Rate, Study Finds, Will Chu, CRTonline, 4/24/2023
Low Lead Extraction Rates With Endocarditis Raise Alarm, Crystal Phend, MedPage Today April 24, 2023
Low Use of Lead Extraction for Device-Related Endocarditis Spurs ‘Call to Arms’, Todd Neale, tctMD, April 24,2023