https://orcid.org/0000-0002-7122-6053
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ABSTRACT
Introduction
Pacemaker-dependent (PM) patients with cardiac implantable electronic device (CIED) infection require implantation of a temporary-pacemaker (TP) and delayed endocardial reimplantation or implantation of an epicardial-pacing-system (EPI) before device extraction. Our aim was to compare the TP and EPI-strategy after CIED extraction through a meta-analysis.
Methods
We searched electronic databases up to 25 March 2022, for observational studies that reported clinical outcomes of PM-dependent patients implanted with TP or EPI-strategy after device extraction.
Results
3 studies were included enrolling 339 patients (TP: 156 patients; EPI: 183 patients). TP compared to EPI showed reduction in the composite outcome of relevant complications (all-cause death, infections, need for revision or upgrading of the reimplanted CIED) (12.1% vs 28.9%; RR: 0.45; 95%CI: 0.25–0.81; p = 0.008) and a trend in reduction of all-cause death (8.9% vs 14.2%; RR: 0.58; 95%CI: 0.33–1.05; p = 0.07). Furthermore, TP-strategy proved to reduce need of upgrading (0% vs 12%; RR: 0.07; 95%CI: 0.01–0.52; p = 0.009), reintervention on reimplanted CIED (1.9% vs 14.7%; RR: 0.15; 95%CI: 0.05–0.48; p = 0.001) and significant increase in pacing threshold (0% vs 5.4%; RR: 0.17; 95%CI: 0.03–0.92; p = 0.04), with a longer discharge time (MD: 9.60 days; 95%CI: 1.98–17.22; p = 0.01).
Conclusion
TP-strategy led to a reduction of the composite outcome of all-cause death and complications, upgrading, reintervention on reimplanted CIED, and risk of increase in pacing threshold compared to EPI-strategy, with longer discharge time.
Abbreviations
| CIED | = | Cardiac Implantable Electronic Device |
| EPI | = | Epicardial |
| LV | = | Left Ventricular |
| PM | = | Pacemaker |
| TP | = | Temporary pacemaker |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.
Authors’ contribution
A.P. conceived the study. A.P., G.V., R.C., and M.A. did the literary search and screened the articles for inclusion. M.M. resolved any discrepancy. G.V. and G.D. performed statistical analyses. SSAA provided data for the article. All authors interpreted the results. A.P., G.V., P.P., G.C., and D.G.D.R. wrote the first and the final draft of the manuscript. R.F., G.D.B., and P.C. have done editing and supervision. All authors critically reviewed the manuscript. All authors read and approved its final version.