Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices

Authors

Justin Z. Lee, Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ.
Monil Majmundar, Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, NY; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH.
Ashish Kumar, Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH.
Samarthkumar Thakkar, Rochester Regional HealthFollow
Harsh P. Patel, Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL.
Dan Sorajja, Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ.
Arturo M. Valverde, Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ.
Ankur Kalra, Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Yong-Mei Cha, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Siva K. Mulpuru, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Samuel J. Asirvatham, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Christopher V. Desimone, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Abhishek J. Deshmukh, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

Department

Medicine

Document Type

Article

Publication Title

Heart Rhythm

Abstract

BACKGROUND: Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality and morbidity. OBJECTIVE: This study sought to evaluate the impact of early versus delayed transvenous lead removal (TLR) on in-hospital mortality and outcomes in patients with CIED infection. METHODS: Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2016, to December 31, 2018. The timing of the TLR procedure was determined based on hospitalization days after initial admission for CIED infection. The impact of early (≤ 7 days) versus delayed (> 7 days) TLR on mortality and major adverse events was studied. RESULTS: Of 12,999 patients who underwent TLR for CIED infections, 8,834 patients underwent early TLR versus 4,165 patients who underwent delayed TLR. Delayed TLR was associated with a significant increase in in-hospital mortality (8.3% vs. 3.5%, adjusted odds ratio:1.70; 95% confidence interval, 1.43-2.03; P value< 0.001). Subgroup analysis of patients with CIED infection and systemic infection showed that delayed TLR in patients with systemic infection was associated with a higher rate of in-hospital mortality compared with early TLR (10.4% vs. 7.5%, adjusted odds ratio:1.24; 95% confidence interval, 1.04-1.49; P value< 0.019). Delayed TLR was also associated with significantly higher adjusted odds of major adverse events and post-procedural length of stay. CONCLUSIONS: These data suggest that delayed transvenous lead removal in patients with CIED infections is associated with increased in-hospital mortality and major adverse events, especially in patients with systemic infection.

First Page

768

Last Page

775

DOI

10.1016/j.hrthm.2021.12.023

Volume

19

Issue

5

Publication Date

5-2022

PubMed ID

34968739

Recommended Citation

Lee, J. Z., Majmundar, M., Kumar, A., Thakkar, S., Patel, H. P., Sorajja, D., Valverde, A. M., Kalra, A., Cha, Y., Mulpuru, S. K., Asirvatham, S. J., Desimone, C. V., & Deshmukh, A. J. (2022). Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices. Heart Rhythm, 19 (5), 768-775. https://doi.org/10.1016/j.hrthm.2021.12.023