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