• Heart Rhythm · Jun 2015

    Comparative Study

    Comparison of delayed transvenous reimplantation and immediate surgical epicardial approach in pacing-dependent patients undergoing extraction of infected permanent pacemakers.

    • Sana Amraoui, Manav Sohal, Adrian Li, Steven Williams, Paul Scully, Tom Jackson, Simon Claridge, Jonathan Behar, Philippe Ritter, Laurent Barandon, Sylvain Ploux, Pierre Bordachar, and Christopher A Rinaldi.
    • Université de Bordeaux, Hopital Haut-Lévêque, LIRYC, Pessac, France. Electronic address: sana.amraoui@hotmail.com.
    • Heart Rhythm. 2015 Jun 1;12(6):1209-15.

    BackgroundPacemaker infection in pacing-dependent patients is challenging. After extraction, temporary pacing usually is utilized before delayed reimplantation (after an appropriate course of antibiotics), resulting in prolonged hospital stays. A single combined procedure of epicardial (EPI) pacemaker implantation and system extraction may prevent this.ObjectiveThe purpose of this study was to evaluate the feasibility and safety of these 2 approaches by comparing clinical outcome for both strategies over 1 year.MethodsIn center 1, 80 consecutive pacemaker-dependent patients underwent extraction with an externalized pacemaker and delayed implantation on the contralateral side (ENDO group). In center 2, 80 consecutive patients had 2 epicardial ventricular leads surgically implanted with extraction of the infected pacemaker during the same procedure (EPI group). Patients were followed-up for 12 months.ResultsOne hundred sixty pacing-dependent patients were successfully implanted and extracted (ENDO group 71 ± 13 years vs EPI group 73 ± 14, P = NS). In the EPI group, 2 patients developed significant pericardial bleeding. In-hospital mortality was 0% in the ENDO group and 2.5% in the EPI group. Total hospitalization time was 15 ± 7 days in the ENDO group vs 9 ± 6 days in the EPI group (P <.001). At 1 year, no infection recurrences occurred in either group, and mortality was equal (5% in each group). Median 1-year pacing thresholds were lower in the ENDO vs the EPI group (0.8 ± 0.6 V vs 1.1 ± 0.6 V, P = .02).ConclusionThe ENDO and EPI strategies had an excellent success rate and low risk of complications. A single procedure using surgical epicardial lead implantation was associated with a shorter duration of hospital stay.Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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