Rate of cardiovascular implantable electronic device (CIED) re-extraction after recurrent infection

Background Patients who develop a cardiovascular implantable electronic device (CIED) infection requiring extraction may have risk factors that make them prone to developing another infection of the reimplanted CIED. However, the rate of a second infection requiring repeat extraction in such patients is unknown and may have important clinical implications. Methods We retrospectively reviewed all patients at our institution from January 2001 to October 2012 who underwent a CIED extraction for an infection and then required reimplantation. We then reviewed the incidence of a repeat extraction due to a second infection. Clinical and device parameters at the time of the second infection were retrieved. Results There were 168 patients who underwent a CIED extraction because of infection and were subsequently reimplanted. The median time to reimplantation was 3 [1^st quartile: 1, 3^rd quartile: 10] days. After a mean follow-up of 4.4 ± 2.7 years, nine (5.4%) patients underwent a repeat CIED extraction due to a second infection. Six repeat extractions (67%) occurred in the first year, leading to an event rate of 3.9% within 1 year of reimplantation. Patients with a second infection requiring a repeat CIED extraction were younger (57 ± 20 vs 68 ± 16, P = 0.046). Pocket infection was the most common presentation of a second infection, occurring in eight of the nine patients. Conclusion The rate of a second infection leading to a CIED repeat extraction is elevated within the first year after reimplantation. To determine predictors of recurring infection, analysis of a larger multicenter series is warranted.