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Is there an optimal timing for device reimplantation after lead extraction due to CIED infection?
Session:
SESSÃO DE POSTERS 45 - DISPOSITIVOS CARDÍACOS IMPLANTÁVEIS: COMPLICAÇÕES E SUA PREVENÇÃO
Speaker:
André Paulo Ferreira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Cartazes
FP Number:
---
Authors:
André Paulo Ferreira; Margarida Figueiredo; Hélder Santos; Guilherme Portugal; Ana Lousinha; Pedro Silva Cunha; Bruno Valente; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Complete cardiovascular implantable electronic devices (CIED) removal is recommended for all patients (P) with confirmed CIED infection, regardless of whether there is definite evidence of device involvement. However, optimal timing following transvenous lead removal remains unclear when considering device reimplantation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>Our study aimed to evaluate the short and long-term effects of different device reimplantation times in P that underwent CIED removal due to infection. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Prospective single-centre study in P that underwent lead extraction due to CIED infection and in whom device reimplantation was performed. P were divided into three groups, according to the timing of device reimplantation: Group A (reimplantation in <72h), Group B (reimplantation in 72h-2 weeks), and Group C (reimplantation in >2 weeks). Relevant outcomes during f</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ollow-up of the three groups were noted in the short-term - need for urgent surgical intervention or death/complications/reintervention during hospitalisation - and in the long-term – one-year mortality or rehospitalisation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>From a total of 257 P, CIED infection was present in 205 P (80%). 116 P (57%) underwent device reimplantation, which was performed in the same hospitalization in 110 P. At baseline 78% were male, median age was 75 (IQR 62-82) years, median dwell time of the leads was 84 (IQR 36-132) months. In 55% of the cases there was pocket infection only, 66 P (32%) had positive blood cultures, 39 P (19%) were under targeted antibiotic therapy and 80 P (39%) had positive cultures after the procedure. Regarding the extracted CIED, 47% were pacemakers (8% VVI, 8% VDD and 31% DDD), 6% were ICD and 11% were CRT – median number of extracted electrodes was 2 (IQR 1-2). Median time to reimplantation after device removal in patients with positive blood cultures was 5 (IQR 2-7) days. Regarding device reimplantation, there were 38 P in group A, 60 P in group B and 18 P in Group C. Differences between the three groups in terms of blood cultures, targeted antibiotic therapy and pre and post-device removal duration of antibiotic therapy are shown in table 1. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Median follow-up time was 26 (IQR 13-54) months. The differences between the three groups regarding short and long-term follow-up outcomes are shown in table 2. </span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In our study, distinct timings of device reimplantation after CIED extraction due to infection did not show differences regarding short or long-term follow-up. </span></span></p>
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