Impact of timing of transvenous lead removal on outcomes in infected cardiac implantable electronic devices

Background: Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality and morbidity. Objective: This study sought to evaluate the impact of early vs delayed transvenous lead removal (TLR) on in-hospital mortality and outcomes in patients with CIED infection. Methods: Using the nationally representative, all payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2016, and December 31, 2018. The timing of TLR was determined on the basis of hospitalization days after the initial admission for CIED infection. The impact of early (≤7 days) vs delayed (>7 days) TLR on mortality and major adverse events was studied. Results: Of the 12,999 patients who underwent TLR for CIED infection, 8834 (68%) underwent early TLR and 4165 (32%) underwent delayed TLR. Delayed TLR was associated with a significant increase in in-hospital mortality (8.3% vs 3.5%; adjusted odds ratio 1.70; 95% confidence interval 1.43–2.03; P < .001). Subgroup analysis of patients with CIED infection and systemic infection showed that delayed TLR in patients with systemic infection was associated with a higher rate of in-hospital mortality compared with early TLR (10.4% vs 7.5%; adjusted odds ratio 1.24; 95% confidence interval 1.04–1.49; P < .019). Delayed TLR was also associated with significantly higher adjusted odds of major adverse events and postprocedural length of stay. Conclusion: These data suggest that delayed TLR in patients with CIED infection is associated with increased in-hospital mortality and major adverse events, especially in patients with systemic infection.