Leadless pacemaker implantation after explantation of infected conventional pacemaker systems: A viable solution?

Abstract

Background: Conventional cardiac device infections are increasing in incidence, causing significant morbidity and mortality. Leadless pacemaker (LP) therapy may provide new opportunities for the management of pacemaker (PM) infections as it does not require implantation of transvenous leads and a pectoral pocket.

Objective: We sought to evaluate the effect of early and late LP implantation in patients diagnosed with device infection.

Methods: Patients receiving an LP at our center after conventional PM lead extraction due to infection between December 1, 2013 and November 30, 2017 were included.

Results: A total of 17 patients (mean age 77.4 ± 7.77 years) underwent LP implantation (ie, 11 with Nanostim leadless cardiac pacemaker [Abbott, Chicago, IL] and 6 with Micra transcatheter pacing system [Medtronic, Minneapolis, MN]) after successful PM system explantation. In 9 PM-dependent patients, a temporary transvenous pacing system was placed as a bridge to permanent LP implantation. Early LP implantation was performed in 6 patients (<1 week), and in the remaining patients, the LP was placed at a later stage (>1 week). All patients experienced no LP infection during a mean follow-up of 16 ± 12 months, including 7 patients with a history of recurrent device infections with a mean follow-up of 20 ± 14 months.

Conclusion: Early and late LP placement after infected conventional pacing system explantation was a viable option in our case series. This therapy may provide an alternative strategy in the management of device infection, if confirmed by subsequent prospective randomized trials, particularly for patients who are PM dependent or have a history of recurrent device infections.

Keywords: Conventional pacemaker therapy; Device and lead extraction; Device infection; Leadless pacemaker therapy; Micra transcatheter pacing system; Nanostim leadless cardiac pacemaker.