Outcomes of patients with definite and possible infective endocarditis related to a cardiac implantable electronic device

Abstract

Introduction: Diagnosis of lead related infective endocarditis (LRIE) is often a real challenge. Current diagnostic criteria include LRIE definite and possible.

Objectives: Comparison of the outcomes of patients with definite and possible LRIE undergoing transvenous lead extraction (TLE) procedures.

Patients and methods: A retrospective analysis of data from 3782 patients undergoing TLE between 2006 and 2023 was performed. The study included 838 patients with definite and possible LRIE. The analysis of clinical data and short and long-term survival was performed.

Results: The comparison of clinical data showed more frequent occurrence of vegetations (81.58% vs 37.21%; P <0.001), positive blood cultures (66.12 % vs 51.64%; P <0.001) and septic pulmonary embolism (40.14% vs 13.78%; P <0.001) in patients with definite LRIE. Long-term mortality of patients with definite and possible LRIE (median follow up 4.61 [1.04–9.40] and 5.06 [2.07–8.75] years respectively) was 61.14% vs 49.29%; P <0.001. Predictors of mortality in patients with marked LRIE include advanced age, low left ventricular ejection fraction (LVEF), comorbidities, septic pulmonary embolism, positive blood culture, and the presence of an abandoned lead. In possible LRIE, only the influence of advanced age, low LVEF and comorbidities was demonstrated. There has been no documented direct impact of delayed diagnosis on the long-term survival of patients after TLE

Conclusions: The study documented better survival in patients with possible LRIE, which confirms the need to use extended diagnostic criteria for LRIE. Implementation of appropriate treatment at an early stage of infection allows for improved prognosis.