Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Extraction/Removal D-MP05 - Lead Extraction and CIED Infection - Risk Management (ID 9) Moderated ePoster

D-MP05-05 - Early Versus Delayed Lead Extraction In Patients With Infected Cardiovascular Implantable Electronic Device (ID 1382)


Background: Cardiovascular implantable electronic device (CIED) infections are associated with high morbidity and mortality. Prior studies have demonstrated improved survival with CIED extraction compared to antibiotic therapy alone. The impact of timing of CIED extraction has not been well-defined.
Objective: To assess the effect of early versus delayed lead extraction on outcomes in patients presenting with infected CIED.
Methods: All infected CIED extraction cases at UC San Diego from 2006 to 2019 were reviewed. Patients were divided into two groups based on the presence of bacteremia or local pocket infection. We assessed the clinical outcomes of in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, with cutoff being seven days from the day of admission.
Results: Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Early CIED extraction is associated with decreased 1-year mortality in both groups (Figure 1). Bacteremic patients who underwent early extraction (n = 33) experienced decreased prevalence of septic shock (6% vs 27%, p = 0.013), acute kidney injury (18% vs 62%, p < 0.01), and antibiotic duration (46 ± 17 vs 53 ± 14 days, p < 0.01). Locally infected patients who underwent early extraction (n = 90) had decreased antibiotic duration (22 ± 12 vs 31 ± 11 days, p < 0.01). There was no difference in complication rate, procedure time, or fluoroscopy time.
Conclusion: Delayed infected CIED extraction is associated with worse in-hospital morbidity and 1-year mortality. This underscores the importance of early detection and a strategy for prompt management including lead extraction.