Concomitant Leadless Pacing in Pacemaker Dependent Patients Undergoing Transvenous Lead Extraction for Active Infection: Mid-Term Follow-Up.
BACKGROUND
The rate of transvenous lead extractions (TLEs) due to cardiac implantable electronic device (CIED) infection continues to rise. CIED infections are associated with significant morbidity and mortality. Temporary pacing in patients with active CIED infections following TLEs can be challenging. Leadless pacing has emerged as an alternative approach in this patient population.


OBJECTIVE
To describe the outcomes of a strategy using concomitant leadless pacemaker implantation and TLE in patients with active infections and ongoing pacing requirements.


METHODS
This study involved all leadless pacemaker implants performed during a TLE between June 2018 and September 2022 in the setting of an active infection. Demographics, procedural details, and clinical outcomes were analyzed.


RESULTS
Eighty-six patients with indications for ongoing pacing, average age 77.4 ± 10.5 years, 70% male underwent a TLE and concomitant leadless pacemaker implant in the setting of active infection. There were no procedure-related complications. 65 patients (76%) had evidence of bacteremia, 80% of whom were discharged to complete their antimicrobial treatment. During a median follow-up of 163 days (IQR: 57,403 days), there were no recurrent infections. Of the 25 deaths (29%) during the study period, 22 (88%) were unrelated to the initial infection. Nine deceased patients (36%) had methicillin-resistant Staphylococcus aureus (MRSA) or Candida infections, three of which had persistent infections despite the TLE.


CONCLUSION
Leadless pacing is a safe and efficacious approach for management of patients with pacing requirements that undergo a CIED extraction in the setting of an active infection.