Rhythm Bridging Options after Transvenous Lead Extraction

Objectives: Transvenous lead extraction (TLE) due to cardiac implantable device (CIED) infection requires implementation of reliable and reproducible rhythm bridging solutions until CIED reimplantation can be performed. This study was conducted to evaluate the efficacy and safety of temporary pacing in bradycardia and wearable cardioverter defibrillator (WCD) in tachyarrhythmia patients.

Methods: We retrospectively reviewed all our patients undergoing transvenous lead extraction (TLE) due to local or systemic CIED infection during a 5-year period (October 2011 - September 2016). Only TLE with lead age > 1 year were included into the study. Pacemaker dependent patients received transvenous pacing lead with active fixation via internal jugular vein connected to external generator. Patients after implantable cardioverter generator (ICD) explantation were evaluated for WCD.

Results: A total of 441 infected leads were extracted in 205 patients (mean age 72 years, 78% males). The indication for TLE was pocket infection in 71% and endocarditis in 29%. 71 patients required temporary active fixation lead (35%). There were no complications related to the temporary lead implantation or temporary pacing until permanent system could be implanted. From 86 patients after ICD extraction, 30 (35%) received WCD and were discharged from hospital. These patients wore WCD for a median of 56 days with a mean daily use of 22 ± 2 hours. Episodes of ventricular tachycardia (VT) occurred in 4 patients, from which 1 required WCD treatment (shock). There were no inappropriate shocks and no documented asystole. After the end of WCD use, only 18 patients (60%) received ICD.

Conclusion: Temporary pacing with active fixation lead can safely bridge the period to implantation of permanent system in pacemaker dependent patients undergoing TLE because of CIED infection. WCD can prevent both SCD and premature ICD implantation after extraction of infected leads.