Management of Cardiovascular Implantable Electronic Device Infection Utilizing a Multidisciplinary Team: A Retrospective Cohort Study

Background. Significant numbers of cardiac implantable electronic devices are placed in the United States, and infection can be a severe consequence of implantation. Despite guideline recommendations and data demonstrating that lead extraction improves mortality for patients with device infection, rates of lead removal are lower than guideline recommendations. We report the outcomes associated with management of suspected cardiac implantable electronic device infections by a multidisciplinary team. Methods. Patient cases were identified from an institutional multidisciplinary endocarditis team registry in a single-center retrospective study. Demographic, treatment, and outcomes data were recorded by study investigators. Results. Between September 7, 2021, and February 1, 2024, 80 consecutive patients with suspected cardiac implantable electronic device infections were identified. Fifty-four (67.5%) patients, including 27/35 (77.1%) with definitive device infection/endocarditis and 30/30 (100%) with pocket infections, underwent device removal at a median of 3 days after admission to the authors’ institution. In-hospital and 90-day mortality was numerically lower in patients who underwent device removal compared with those who did not (13% vs 19.2%; P = .47 and 22.2% vs 38.5%; P = .13), and 1-year mortality was significantly lower for patients who underwent device removal (34% vs 70.1%; P = .01). Only 48.1% of patients had a device replaced during the study period. Conclusions. The use of a multidisciplinary team for management of suspected cardiac implantable electronic device infections was associated with high rates of expedient device extraction and relatively low rates of device reimplantation. One-year mortality was lower in patients who underwent device extraction.