open access

Vol 22, No 1 (2015)
Original articles
Published online: 2015-02-24
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Cardiac implantable electronic device lead extraction in patients with underlying infection using open thoracotomy or percutaneous techniques

Divyang Patel, Faris Khan, Hemal Shah, Sanjoy Bhattacharya, Evan Adelstein, Samir Saba
DOI: 10.5603/CJ.a2014.0038
·
Pubmed: 24846514
·
Cardiol J 2015;22(1):68-74.

open access

Vol 22, No 1 (2015)
Original articles
Published online: 2015-02-24

Abstract

Background: Explanting infected cardiac implantable electronic devices (CIEDs) and extracting their associated leads can be performed percutaneously (EP) or via open-thoracotomy (OR) approach. In this study, we examined the characteristics and outcomes of infected CIED patients undergoing EP vs. OR extraction procedures.

Methods: All patients (EP: n = 329 and OR: n = 24) who received lead extraction in the presence of an infected CIED from 2005 to 2010 at the University of Pittsburgh Medical Center were included in this study. Demographic and clinical characteristics were obtained from the electronic medical records. The Charlson comorbidity index (CCI) was used to adjust for severity of co-morbid conditions.

Results: Compared to the EP group, OR patients were more likely to have positive blood cultures, larger vegetations, and worse CCI scores. They also had higher total mortality rates at 1 (p = 0.036), 6 (p = 0.020), and 12 months (p = 0.012) after the procedure. One-year survival after lead extractions was significantly better for the EP compared to the OR group (p = 0.002) even after adjusting for other comorbid illnesses (HR = 2.6, p = 0.010) in a Cox regression model.

Conclusions: Infected CIED patients undergoing open-chest lead extraction are sicker and have higher mortality rates compared to those undergoing percutaneous extraction. Randomized, prospective data are needed to determine whether the procedural strategy for lead extraction accounts in part for the difference in outcome.

Abstract

Background: Explanting infected cardiac implantable electronic devices (CIEDs) and extracting their associated leads can be performed percutaneously (EP) or via open-thoracotomy (OR) approach. In this study, we examined the characteristics and outcomes of infected CIED patients undergoing EP vs. OR extraction procedures.

Methods: All patients (EP: n = 329 and OR: n = 24) who received lead extraction in the presence of an infected CIED from 2005 to 2010 at the University of Pittsburgh Medical Center were included in this study. Demographic and clinical characteristics were obtained from the electronic medical records. The Charlson comorbidity index (CCI) was used to adjust for severity of co-morbid conditions.

Results: Compared to the EP group, OR patients were more likely to have positive blood cultures, larger vegetations, and worse CCI scores. They also had higher total mortality rates at 1 (p = 0.036), 6 (p = 0.020), and 12 months (p = 0.012) after the procedure. One-year survival after lead extractions was significantly better for the EP compared to the OR group (p = 0.002) even after adjusting for other comorbid illnesses (HR = 2.6, p = 0.010) in a Cox regression model.

Conclusions: Infected CIED patients undergoing open-chest lead extraction are sicker and have higher mortality rates compared to those undergoing percutaneous extraction. Randomized, prospective data are needed to determine whether the procedural strategy for lead extraction accounts in part for the difference in outcome.

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Keywords

cardiac implantable electronic devices, infection, lead extraction, thoracotomy

About this article
Title

Cardiac implantable electronic device lead extraction in patients with underlying infection using open thoracotomy or percutaneous techniques

Journal

Cardiology Journal

Issue

Vol 22, No 1 (2015)

Pages

68-74

Published online

2015-02-24

DOI

10.5603/CJ.a2014.0038

Pubmed

24846514

Bibliographic record

Cardiol J 2015;22(1):68-74.

Keywords

cardiac implantable electronic devices
infection
lead extraction
thoracotomy

Authors

Divyang Patel
Faris Khan
Hemal Shah
Sanjoy Bhattacharya
Evan Adelstein
Samir Saba

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