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Journal of Interventional Cardiac Electrophysiology

09-03-2024 | ICD Infection

Impact of infective versus sterile transvenous lead removal on 30-day outcomes in cardiac implantable electronic devices

Authors: Fahimeh Talaei, Qi-Xuan Ang, Min-Choon Tan, Mustafa Hassan, Luis Scott, Yong-Mei Cha, Justin Z. Lee, Kamala Tamirisa

Published in: Journal of Interventional Cardiac Electrophysiology

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Abstract

Background

Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection.

Methods

From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied.

Results

Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33–6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23–4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97–1.29) or vascular complications (OR = 1.12; 95% CI 0.73–1.72) between the two groups.

Conclusion

Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients.
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Metadata
Title
Impact of infective versus sterile transvenous lead removal on 30-day outcomes in cardiac implantable electronic devices
Authors
Fahimeh Talaei
Qi-Xuan Ang
Min-Choon Tan
Mustafa Hassan
Luis Scott
Yong-Mei Cha
Justin Z. Lee
Kamala Tamirisa
Publication date
09-03-2024
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-024-01775-1