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Review
. 2025 Oct;68(7):1523-1529.
doi: 10.1007/s10840-024-01960-2. Epub 2024 Dec 5.

Outcomes of concurrent and delayed leadless pacemaker implantation following extraction of infected cardiovascular implantable electronic device

Bilawal Nadeem  1   2 , Surik Sedrakyan  3   4 , Amel Fatima  5 , Mirza Mehmood Ali Baig  6 , Ali Ahmed  6 , Mifrah Rahat Khan Sherwani  7 , John Wylie  8   9
Affiliations
Review

Outcomes of concurrent and delayed leadless pacemaker implantation following extraction of infected cardiovascular implantable electronic device

Bilawal Nadeem et al. J Interv Card Electrophysiol. 2025 Oct.

Abstract

Introduction: The optimal reimplantation strategies following the removal of infected cardiovascular implantable electronic devices (CIEDs) remain inadequately understood. Given the limitations and risks associated with traditional approaches, the investigation of alternative devices, such as leadless pacemakers (LPs), has gained attention due to their potentially lower infection risk.

Methods: We reviewed literature sources including PubMed, Scopus, and Embase, utilizing a combination of search terms. The inclusion criterion was leadless pacemaker (LP) implantation following lead removal (LR) of infected CIEDs, while the exclusion criterion was LR for noninfectious indications. Study endpoints encompassed patient outcomes during follow-up.

Results: Our literature review yielded 827 articles, of which 22 met the inclusion criteria, encompassing a cohort of 657 patients who underwent LR followed by LP implantation. A total of 295 (44.9%) patients underwent concurrent LP implantation during the LR procedure. The rest underwent delayed procedures, and the overall duration between LR of infected CIED and LP implantation was 4.32 ± 3.9 days. A total of 194 (29.5%) patients had systemic CIED infections, whereas 153 (23.3%) had isolated pocket infections. In our patient cohort, procedural complications were scarce. Over a mean follow-up period of 13.3 ± 9.4 months, pacemaker syndrome was observed in 4 patients (0.61%), and 3 patients (0.46%) experienced persistent or recurrent infections.

Conclusion: Our review finds both concurrent and delayed LP implantation after infected CIED extraction to be safe, with low reinfection rates and minimal complications. LPs could also serve as a bridge to CRT re-implantation minimizing the use of temporary pacing systems.

Keywords: Infected cardiac implantable electronic device; Leadless pacemaker implantation; Micra pacing system; Procedural outcomes; Transvenous lead explant; Transvenous lead extraction; Transvenous lead removal.

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Conflict of interest statement

Declarations. Ethics approval: This is an observational study. The St. Elizabeth’s Medical Center Research Ethics Committee has confirmed that no ethical approval is required. Consent to participate: This is an observational study. The St. Elizabeth’s Medical Center Research Ethics Committee has confirmed that no consent is required. Consent for publication: This is an observational study. The St. Elizabeth’s Medical Center Research Ethics Committee has confirmed that no consent is required. Competing interests: The authors declare no competing interests.

References

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