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Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week (JACC April 2023-1)

Infection remains a serious complication associated with the cardiac implantable electronic devices (CIED). This review assesses the burden of CIED infection, evidence for treatment recommendations, and solutions to barriers. CIED infections are associated with substantial clinical and economic burden globally. Five clinical practice guidelines reported Class I recommendations for complete system and lead removal for CIED infection. Clinical studies assessing CIED extraction for infection consistently reported high procedural success, low major procedural complication rates, and very low procedural mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. A large physician survey reported poor compliance with recommendations. Barriers to optimal treatment may include diagnosis and referral challenges, and misconceptions regarding extraction procedures. Education of all stakeholders and implementation of simple solutions such as an Electronic Medical Record alert system may address barriers.


Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Dhanunjaya Lakkireddy, MD
Ami Sood, MD 

Important Dates
Date of Release: March 27, 2023

Term of Approval/Date of CME/MOC Expiration: March 26, 2024

Availability: On-Demand
Expires on Mar 26, 2024
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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