Assessment of adverse events stratified by timing of leadless pacemaker implantation with cardiac implantable electronic devices extraction due to infection: A systematic review and meta-analysis

Abstract

Background

Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear.

This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal.

Methods

Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors.

Results

Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, I²: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, I²: 4%) for LP implantation after CIED extraction (p = .009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, I²: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, I²: 21%) after extraction (p = 0.008). Reinfection was not observed in any of these studies.

Conclusion

Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.