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，心脏植入式电子器械（cardiac implantable electronic devices）的植入量持续攀升，与之伴随的是相关并发症（尤以感染为甚）的发生率亦同步升高。当前针对心脏植入式电子器械相关感染的规范化治疗建议为长期抗生素治疗联合完全器械取出术。本研究旨在针对经皮器械取出术（percutaneous extraction）在该类感染治疗中的价值展开分析。

方法：本研究在PubMed、BVS、Cochrane CENTRAL、CAPES、SciELO及ScienceDirect数据库中开展系统性综述检索，共检索得到1717项研究，随后由两名研究者独立依据相关性筛选标准完成资格遴选。

结果：最终入选16项研究，共涉及3354名患者，其中3081名患者接受了经皮器械取出术。感染器械完全经皮取出的平均成功率为92.4%。本次手术的重大并发症发生率为2.9%，轻微并发症发生率为8.4%。患者院内平均死亡率为5.4%，手术相关死亡率介于0.4%至3.6%之间。术后6个月平均死亡率为20%，一年随访期内平均死亡率为14%。

结论：经皮器械取出术是感染性心脏植入式电子器械取出的主流术式，其手术相关并发症与死亡率均处于较低水平。