Percutaneous Lead Extraction in Infection of Cardiac Implantable Electronic Devices: a Systematic Review

Abstract Introduction: In the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections. Methods: A systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently. Results: Sixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up. Conclusion: Percutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.

摘要 引言：近二十年来，心脏植入式电子设备（cardiac implantable electronic devices）的植入数量持续增加，与之伴随的是其相关并发症尤其是感染的发生率不断上升。现行针对心脏植入式电子设备相关性感染的诊疗指南推荐，需采用延长抗生素治疗联合完全取出植入设备的方案。本研究旨在分析经皮取出术（percutaneous extraction）在该类设备相关性感染治疗中的应用价值。
方法：本研究在PubMed、BVS、Cochrane CENTRAL、CAPES、SciELO及ScienceDirect数据库中开展系统综述检索。共检索到1717项研究，随后由两名独立开展工作的研究者依据基于相关性检验制定的纳入排除标准进行筛选。
结果：最终纳入16项研究，共涉及3354例患者，其中3081例接受了经皮取出术。感染设备完全经皮取出的平均成功率为92.4%。手术相关并发症方面，严重并发症发生率为2.9%，轻微并发症发生率为8.4%。患者平均住院死亡率为5.4%，手术相关死亡率介于0.4%至3.6%之间。术后6个月的平均死亡率为20%，1年随访后的平均死亡率为14%。
结论：经皮取出术是感染性心脏植入式电子设备取出的主流术式，其手术相关并发症及死亡率均处于较低水平。