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Objectives: This study sought to assess the impact of previously abandoned leads on the clinical management of cardiac device infections, notably transvenous lead extraction and subsequent clinical course., Background: The population of patients with cardiac implantable electronic devices continues to grow with a disproportionate increase in device infections, which are invariably life threatening. A potentially complicating issue is the widely practiced strategy of device lead abandonment at the time of system revision, change, or upgrade, which is affecting an increasing number of patients., Methods: The study assessed the impact of previously abandoned leads in a prospectively maintained registry of consecutive patients undergoing percutaneous extraction of infected cardiac devices at the Cleveland Clinic between August 1996 and September 2012. The primary clinical endpoint was complete procedural and clinical success defined as the successful removal of the device and all lead material from the vascular space, in the absence of a major complication., Results: Of 1,386 patients with infected cardiac devices, 323 (23.3%) had previously abandoned leads. Failure to achieve the primary endpoint occurred more frequently in patients with abandoned leads (13.0% vs. 3.7%; p < 0.0001). This was primarily due to retention of lead material (11.5% vs. 2.9%; p < 0.0001), which was associated with poor clinical outcomes including higher rates of 1-month mortality (7.4% vs. 3.5% in those without lead remnants). Lead extraction procedures in patients with previously abandoned leads were longer (p < 0.0001), with longer fluoroscopy times (p < 0.0001), and more likely to require specialized extraction tools (94.4% vs. 81.8%; p < 0.0001) or adjunctive rescue femoral workstations (14.9% vs. 2.9%; p < 0.0001). Procedural complications occurred more frequently in patients with previously abandoned leads (11.5% vs. 5.6%; p = 0.0003), which was true for both major (3.7% vs. 1.4%; p = 0.009) and minor complications (7.7% vs. 4.4%; p = 0.02)., Conclusions: Previously abandoned leads complicate the management of cardiac device infections, leading to worse clinical outcomes., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study reports a high-volume tertiary care center experience with the microbiology of cardiac implantable electronic devices (CIED) infections with assessment of temporal trends and profiles of late versus early infections., Background: The rates of CIED infections have been increasing. With changing demographics, patient and device characteristics, prophylactic measures, and the wide use of broad-spectrum antibiotics, there is need for updated contemporary data on the microbiology of CIED infections., Methods: The study included 816 consecutive patients with confirmed CIED infections who underwent transvenous lead extraction at our institution between the years 2000 and 2011. Blood cultures were obtained in addition of pocket swabs, pocket capsule, and leads., Results: Staphylococcal species remained the most common pathogens in CIED infections (68.4%), especially coagulase-negative species (37.6%). Methicillin-resistant staphylococci were the pathogens in 33.8% of all CIED infections and accounted for 49.4% of all staphylococcal infections. Gram-negative pathogens were identified in 8.9% of cases, whereas 13.2% were with negative cultures. CIED infections related to streptococci (2.5%), enterococci (4.2%), anaerobes (1.6%), fungi (0.9%), and mycobacteria species (0.2%) were less common. Of pocket infections, 49.5% occurred more than 1 year after pocket manipulation, and 53.6% of these were related to coagulase-negative staphylococci. In contrast, most endovascular infections were related to Staphylococcus aureus. The proportions of culture negative infections have increased (p < 0.0001)., Conclusions: The study provides contemporary data on the microbiology of CIED infections. The rates of methicillin resistance seem to be greater than those reported from the preceding decade., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

The incidence of infection following implantation of cardiac implantable electronic devices (CIEDs) is increasing at a faster rate than that of device implantation. Patients with a CIED infection usually require hospitalisation and complete device and lead removal. A significant proportion die from their infection. Transvenous lead extraction (TLE) is associated with rare but serious complications including major vascular injury or cardiac perforation. Operator experience and advances in lead extraction methods, including laser technology and rotational sheaths, have resulted in procedures having a low risk of complication and mortality. Strategies for preventing CIED infections include intravenous antibiotics and aseptic surgical techniques. An additional method to reduce CIED infection may be the use of antibacterial TYRX™ envelope. Data from non-randomised cohort studies have indicated that antibacterial envelope use can reduce the incidence of CIED infection by more than 80 % in high-risk patients and a randomised clinical trial is ongoing.