Efficacy and safety of same-day procedure involving transvenous lead extraction and leadless pacemaker implantation for cardiac implantable electronic device-related infections

Abstract Background Implantation of leadless pacemakers (LPMs) as replacement cardiac implantable electronic devices (CIEDs) is recommended for CIED-related infections. However, the efficacy and safety of performing transvenous lead extraction (TLE) and LPM implantation simultaneously remain unknown. Object To evaluate the efficacy and safety of performing TLE and LPM implantation simultaneously for CIED-related infections. Methods We retrospectively analyzed the patients who underwent TLE of transvenous pacemaker (PM) and subsequent PM implantation for CIEDs-related infections at our hospital from January 2020 to February 2025. The primary endpoints were the composite of postoperative all-cause mortality and major adverse cardiovascular events. Results We enrolled 38 patients, and successfully performed TLE and PM reimplantation in all cases. The average age was 79.7±8.1 years, with 11 females (28.9%). Among them, 24 patients (63.2%) had atrioventricular block, 9 patients (23.7%) had sick sinus syndrome, and 5 patients (13.2%) had bradycardic atrial fibrillation. The most common causative organism was Staphylococcus aureus, identified in 10 patients (26.3%), while the causative organism remained unknown in 13 patients (34.2%). Among the 38 patients, 23 underwent TLE and leadless pacemaker (LPM) implantation on the same day (Micra in 21 patients 91.3%, Aveir in 2 patients 8.7%). Of these, one patient required invasive reintervention within 30 days postoperatively due to elevated thresholds necessitating reimplantation, and another experienced recurrent bacteremia 35 days later. No significant differences were observed in the composite endpoints of postoperative all-cause mortality or major adverse cardiovascular events between the same-day and separate-day treatment groups. (Figure) Conclusion The same-day procedure combining TLE and LPM implantation is considered effective and safe for CIED-related infections. However, careful consideration is required when determining the indications.