Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices

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Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices. / Breeman, Karel T. N.; Beurskens, Niek E. G.; Driessen, Antoine H. G. et al.

In: Journal of interventional cardiac electrophysiology, 19.12.2022.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{a12044921b91482c96aa8b7701f00751,

title = "Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices",

abstract = "Background: Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers.Methods: We included all patients with LP implantation as a replacement for an infected CIED, between January 2013 and December 2021. The occurrence of reinfection was assessed during standard follow-up visits.Results: Twenty-nine patients (mean age 81 ± 9 years) were included, of which 21 (73%) had a pocket infection, 7 (24%) endocarditis, and 1 (3%) a systemic infection without endocarditis. All LP implantations were successful. LPs were implanted before extraction (n = 4, 13%), simultaneously with extraction (n = 5, 17%) and after extraction (n = 20, 70%). No reinfection occurred during the follow-up of median 32 months (IQR 13-66 months). Repeat blood cultures obtained in 9 (30%) patients and transthoracic echocardiography in all 7 patients with pacemaker endocarditis were negative for reinfection. In a subset of 6 LPs extracted during follow-up due to early battery depletion, prophylactically after the battery advisory or due to non-capture (median 36 months (range 0-67 months) post-implantation), histopathologic examination of tissues around the LPs showed no signs of infection.Conclusions: After replacing infected CIEDs for an LP, no reinfections occurred in over 2.5 years follow-up. These results confirm that in case of CIED infection, the LP is an appealing replacement device. LP implantation before CIED extraction is feasible.",

keywords = "Cardiac implantable electronic device, Extraction, Infection, Leadless pacemaker",

author = "Breeman, {Karel T. N.} and Beurskens, {Niek E. G.} and Driessen, {Antoine H. G.} and Wilde, {Arthur A. M.} and Tjong, {Fleur V. Y.} and Knops, {Reinoud E.}",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2022",

month = dec,

day = "19",

doi = "10.1007/s10840-022-01457-w",

language = "English",

journal = "Journal of interventional cardiac electrophysiology",

issn = "1383-875X",

publisher = "Springer Netherlands",

}

RIS

TY - JOUR

T1 - Timing and mid-term outcomes of using leadless pacemakers as replacement for infected cardiac implantable electronic devices

AU - Breeman, Karel T. N.

AU - Beurskens, Niek E. G.

AU - Driessen, Antoine H. G.

AU - Wilde, Arthur A. M.

AU - Tjong, Fleur V. Y.

AU - Knops, Reinoud E.

PY - 2022/12/19

Y1 - 2022/12/19

N2 - Background: Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers.Methods: We included all patients with LP implantation as a replacement for an infected CIED, between January 2013 and December 2021. The occurrence of reinfection was assessed during standard follow-up visits.Results: Twenty-nine patients (mean age 81 ± 9 years) were included, of which 21 (73%) had a pocket infection, 7 (24%) endocarditis, and 1 (3%) a systemic infection without endocarditis. All LP implantations were successful. LPs were implanted before extraction (n = 4, 13%), simultaneously with extraction (n = 5, 17%) and after extraction (n = 20, 70%). No reinfection occurred during the follow-up of median 32 months (IQR 13-66 months). Repeat blood cultures obtained in 9 (30%) patients and transthoracic echocardiography in all 7 patients with pacemaker endocarditis were negative for reinfection. In a subset of 6 LPs extracted during follow-up due to early battery depletion, prophylactically after the battery advisory or due to non-capture (median 36 months (range 0-67 months) post-implantation), histopathologic examination of tissues around the LPs showed no signs of infection.Conclusions: After replacing infected CIEDs for an LP, no reinfections occurred in over 2.5 years follow-up. These results confirm that in case of CIED infection, the LP is an appealing replacement device. LP implantation before CIED extraction is feasible.

AB - Background: Cardiac implantable electronic device (CIED) infections have a high morbidity and mortality and are an indication of device extraction. As a replacement, leadless pacemakers (LPs) may be preferable due to a low infection risk, but mid-term data on reinfections is lacking. Moreover, early LP reimplantation in pacemaker-dependent patients would circumvent the need for temporary pacemakers.Methods: We included all patients with LP implantation as a replacement for an infected CIED, between January 2013 and December 2021. The occurrence of reinfection was assessed during standard follow-up visits.Results: Twenty-nine patients (mean age 81 ± 9 years) were included, of which 21 (73%) had a pocket infection, 7 (24%) endocarditis, and 1 (3%) a systemic infection without endocarditis. All LP implantations were successful. LPs were implanted before extraction (n = 4, 13%), simultaneously with extraction (n = 5, 17%) and after extraction (n = 20, 70%). No reinfection occurred during the follow-up of median 32 months (IQR 13-66 months). Repeat blood cultures obtained in 9 (30%) patients and transthoracic echocardiography in all 7 patients with pacemaker endocarditis were negative for reinfection. In a subset of 6 LPs extracted during follow-up due to early battery depletion, prophylactically after the battery advisory or due to non-capture (median 36 months (range 0-67 months) post-implantation), histopathologic examination of tissues around the LPs showed no signs of infection.Conclusions: After replacing infected CIEDs for an LP, no reinfections occurred in over 2.5 years follow-up. These results confirm that in case of CIED infection, the LP is an appealing replacement device. LP implantation before CIED extraction is feasible.

KW - Cardiac implantable electronic device

KW - Extraction

KW - Infection

KW - Leadless pacemaker

UR - http://www.scopus.com/inward/record.url?scp=85144235674&partnerID=8YFLogxK

U2 - 10.1007/s10840-022-01457-w

DO - 10.1007/s10840-022-01457-w

M3 - Article

C2 - 36534325

JO - Journal of interventional cardiac electrophysiology

JF - Journal of interventional cardiac electrophysiology

SN - 1383-875X

ER -

ID: 28800003

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