Script for University of Melbourne Poster Presentation

Introduction (1 minute)

Given the aging population, more people suffer from cardiac arrhythmias and heart failure. Cardiac implantable electronic devices provide a long-term solution and improves survival and quality of life. However, complications such as infection and non-infection (device failure) requires clinicians to make a decision on device removal via TLE. The risk of removal include perforation requiring emergency surgery. Evidence suggests that the benefits for removal in infection cases outweighs the risk, but the same cannot be said for non-infectious cases.

The systematic review aims to fill in the gap on whether infection status impacts the outcomes of transvenous lead extraction. Hence, we formulated the research question: What is the outcome of TLE for infection compared to non-infection?

Methods (30 seconds)

For the systematic review, we used an a priori protocol and followed the PRISMA guidelines. Literature searching was done on 4 online medical databases. The unique articles were then initially screened by title and abstract. Full text was retrieved and screened again for eligibility criteria. All included studies were appraised for quality of evidence and risk of bias, A narrative synthesis was used to summarize our findings.

Results and Conclusion (1 minute 30 seconds)

Our results show that 15 observational studies fulfilled our eligibility criteria. We summarized our results into three main points of discussion: rates of success, rates of complication, and specialized sheaths, approach, and procedural duration. First, the rates of success were similar for infection and non-infection. Further look into infections showed that systemic infections had higher rates of success compared to local infections, possibly due to more the inflammation. Secondly, rates of major complication and mortality were similar between the two groups. Venous occlusions (minor complication) were found to be more common in systemic infection compared to local infection. Lastly, the procedures reported in all included studies followed the recommendations appropriate to the guidelines available at the time of study, which was not too different from the latest guideline. In conclusion, our review showed that infection status does not impact the outcome of transvenous lead extraction. However, our review was limited by the poor quality of the included studies. Grey literature and test for homogeneity were not assessed. Clinicians may benefit from this study by knowing that success rates for TLE for non-infection is similar with infection. This review highlights the need for higher quality studies investigating infection status and other factors that might impact the outcome, such as duration of device.