The following is a summary of “Outcomes of complete removal versus conservative therapy in cardiac implantable electronic device infections – A systematic review and Meta-analysis,” published in the June 2024 issue of Cardiology by Caldonazo et al.

Complete removal of cardiac implantable electronic devices (CIEDs) is advised for patients with systemic or localized pocket infection. 

Researchers conducted a prospective study evaluating the latest evidence on the impact of entirely removing cardiac devices in patients with infection.

They reviewed short- and mid-term outcomes in patients with device infections or infective endocarditis (IE). The total, complete removal of cardiac devices (generator and leads) was compared to conservative treatments. The primary focus was on reinfection/relapse, with secondary outcomes being short-term (30-day/in-hospital) and mid-term (mean follow-up: 43.0 months) mortality. A random effects model was also used. 

The results showed  32 studies in the final analysis. Patients with complete CIED extraction (n=905) had a much lower relapse/reinfection rate compared to those with conservative treatment (n=195, OR 0.02, 95% CI: 0.01-0.06, P<0.0001, mean follow-up: 16.1 months). The patients also had a lower short-term (OR 0.40, 95% CI: 0.23-0.69, P=0.01) and mid-term mortality (OR 0.52, 95% CI: 0.34-0.78, P=0.002). 

Investigators concluded that patients with a CIED infection benefited from complete device removal and showed reduced relapse rates and lower short- and mid-term mortality. However, treatment allocation bias may affect the outcomes.

Source: internationaljournalofcardiology.com/article/S0167-5273(24)00886-6/abstract#%20