The most serious complication of cardiac implantable electronic devices: two-decade experience

Cardiac implantable electronic devices (CIED) are well known for their ability to improve quality of life and survival of many patients around the world, despite all the benefits, there is a price to pay. Lead-related infective endocarditis (LRIE) is rare, but an exceptionally serious complication causing considerable harm and even patient death. The aim of this study was to find and analyze all LRIE cases during the last 20 years. This retrospective study evaluated patients who were admitted to Pauls Stradins Clinical University Hospital due to LRIE in time period between January 2000 and December 2020. LRIE cases were found in the procedure journals from Latvian Centre of Cardiology. Sixty-five patients were found to have LRIE, with mean age of 63.8±16.7 years, 44 (67.7%) of them were male, 56 (86.2%) had a permanent paČēmaker, 8 (12.3%) had cardiac resynchronization therapy devices and 1 (1.5%) had an implantable cardioverter-defibrillator. A total of 0.29% of all implantations resulted in LRIE. In 36 (55.4%) patients LRIE developed after reimplantation of CIED, and in 30 (46.2%) cases more than two years after last procedure. Fifty-five (84.6%) patients had visible lead vegetations during transthoracic or transesophageal echocardiography, 7 (11%) patients had heart valve involvement. Fourty-eight (73.8%) patients had received antibacterial treatment before sample collection, 32 (49.2%) had positive blood cultures. Most commonly isolated pathogen was S. aureus (32.3%). Most common comorbidities were chronic heart failure (81.5%) and hypertension (63.1%). Surgical lead extraction was carried out in 43 (66.2%) patients, transvenous in 22 (33.8%), in all cases a complete and successful lead extraction was achieved. Nine (13.8%) patients died due to LRIE. Highly experienced operators (nearly all with >300 CIED implantations per year) and certain preventive measures have resulted in a very low LRIE incidence at our centre.