Evaluation of safety and feasibility of leadless pacemaker implantation following the removal of an infected pacemaker

Abstract

Background: Leadless pacemakers provide safe and effective pacing options for patients with device-related infections. This study was aimed at observing and evaluating the safety and feasibility of extracting an infected pacemaker device followed by the implantation of a leadless pacemaker in the same location for patients without systemic infection.Methods: Between December 2019 and September 2020, following a well-planned reimplantation strategy, pacemaker electrodes were removed from patients with device infection and leadless pacemakers were immediately implanted at our center. The patients were then followed up for up to 10 months to assess the safety and practicality of the procedure.Results: Pacemaker electrode removal and immediate leadless pacemaker implantation were successfully achieved in eight patients with pocket infection. After a minimum follow-up period of 1 month and a maximum follow-up of 10 months, the pacing parameters for the patients remained stable and there was no infection at the original capsular bag or in the leadless pacemaker. Conclusion:Direct implantation of a leadless pacemaker is safe and feasible for patients with local infection of the pacing system after removal of the electrode as an alternative to a bridge period with a temporary pacemaker. This strategy may be a better option for pacing-dependent patients.

Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review

“…The safety of a reimplantation strategy using an LP is supported by other studies in patients with generator pocket infection and systemic involvement [19][20][21][22][23][24].…”

“…Additionally, 11 (55%) patients had positive lead cultures. Antimicrobial therapy was administered for a median time of 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] days after LP placement. The most common administered antimicrobial was daptomycin in 60% of cases.…”

First in human surgical implantation of a leadless pacemaker on the epicardial portion of the right atrial appendage in a patient with a cardiac electronic devices mediated dermatitis

“…Severe pocket complications are rare entity and these patients are good candidates for percutaneous leadless pacemaker implantation after explanting of classic device [ 3 ]; however, existing leadless devices implantation method is limited by the fact that these devices are set up to pace only the ventricles. It has been clearly shown in the scientific literature that this modality of pacing is not optimal for patients with normal atrioventricular nodal function because it causes asynchrony between atria and ventricles.…”

Outcomes of primary leadless pacemaker implantation: A systematic review

“…In the last 10 years, leadless pacemakers (LPMs) have provided an alternative to traditional transvenous (TV) pacemakers (PMs) significantly improving outcomes associated with the need for long‐term pacing (Gonzales et al, 2019; Marschall et al, 2022; Schiavone et al, 2022; Zhang et al, 2021). LPMs have a significantly lower risk of pocket and lead‐related complications frequently seen with TV PMs (Schiavone et al, 2022).…”

“…Adverse events reported with LPMs range between 3.8% and 12.4% and are high in the elderly population (Ngo et al, 2021). First‐generation LPMs only paced the ventricle, limiting their use to atrial fibrillation with block and to patients who contraindication to TV‐PMs (Zhang et al, 2021). The second‐generation LPMs are capable of using VDD pacing, leading to AV synchronous pacing, providing an alternative to patients with atrioventricular (AV) block (Mitacchione et al, 2021).…”