Percutaneous Lead Extraction in Infection of Cardiac Implantable Electronic Devices: a Systematic Review

Abstract

IntroductionIn the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections.MethodsA systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently.ResultsSixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up.ConclusionPercutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.

Cost-Utility Analysis of Percutaneous and Surgery Methods in Extraction of Cardiac Leads Infection

“…(Figure 8). Menezes Junior et al (2018) from 2009 to 2016 with a systematic review In this study, out of 3354 patients, 3081 successfully extracted lead and the success rate was reported by percutaneous method 92.4%. The incidence of severe complications was 2.9 % and the incidence of mild complications was 8.4% and the mortality rate in hospital was 5.4% and the mortality from this method was 0.4 to 3.6%.…”

“…The incidence of severe complications was 2.9 % and the incidence of mild complications was 8.4% and the mortality rate in hospital was 5.4% and the mortality from this method was 0.4 to 3.6%. The average mortality after 6 months was 20% and after one year follow-up was 14% (20). Soheil et al (2011), there were 5817 reception with infection, the rate of reception adjusted with mortality ranged from 4.6 to 11.3% and the duration of hospitalization with infection was between 15.5 to 24.3%.…”

A rare cause of transient ischaemia, ST-segment elevation, and ventricular fibrillation during percutaneous lead extraction

“…Percutaneous lead extraction is sometimes a high-risk procedure and many complications may occur. 2 Probably the most feared and common are pericardial effusion, tamponade, and haemorrhage. Rare causes of acute myocardial infarction during the procedure have been described in the literature, 3 mainly related to injury of the left anterior descending artery by the right ventricular lead, but injury of the coronary arteries by the CS lead is even more anecdotal.…”