Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices.

Published

Journal Article

OBJECTIVES: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). BACKGROUND: The use of transvenous lead extraction for the management CIED infection in patients with a durable LVAD has not been well described. METHODS: Clinical and outcomes data were collected retrospectively among patients who underwent lead extraction for CIED infection after LVAD implantation at Duke University Hospital. RESULTS: Overall, 27 patients (n = 6 HVAD; n = 15 HeartMate II; n = 6 Heartmate III) underwent lead extraction for infection. Median (interquartile range) time from LVAD implantation to infection was 6.1 (2.5 to 14.9) months. Indications included endocarditis (n = 16), bacteremia (n = 9), and pocket infection (n = 2). Common pathogens were Staphylococcus aureus (n = 10), coagulase-negative staphylococci (n = 7), and Enterococcus faecalis (n = 3). Sixty-eight leads were removed, with a median lead implant time of 5.7 (3.6 to 9.2) years. Laser sheaths were used in all procedures, with a median laser time of 35.0 s (17.5 to 85.5s). Mechanical cutting tools were required in 11 (40.7%) and femoral snaring in 4 (14.8%). Complete procedural success was achieved in 25 (93.6%) patients and clinical success in 27 (100%). No procedural failures or major adverse events occurred. Twenty-one patients (77.8%) were alive without persistent endovascular infection 1 year after lead extraction. Most were treated with oral suppressive antibiotics after extraction (n = 23 [82.5%]). Persistent infection after extraction occurred in 4 patients and was associated with 50% 1-year mortality. CONCLUSIONS: Transvenous lead extraction for LVAD-associated CIED infection can be performed safely with low rates of persistent infection and 1-year mortality.

Full Text

Duke Authors

Cited Authors

  • Black-Maier, E; Piccini, JP; Bishawi, M; Pokorney, SD; Bryner, B; Schroder, JN; Fowler, VG; Katz, JN; Haney, JC; Milano, CA; Nicoara, A; Hegland, DD; Daubert, JP; Lewis, RK

Published Date

  • June 2020

Published In

Volume / Issue

  • 6 / 6

Start / End Page

  • 672 - 680

PubMed ID

  • 32553217

Pubmed Central ID

  • 32553217

Electronic International Standard Serial Number (EISSN)

  • 2405-5018

Digital Object Identifier (DOI)

  • 10.1016/j.jacep.2020.02.006

Language

  • eng

Conference Location

  • United States