# Extraction and reimplantation of cardiac implantable electronic devices in patients with non-surgically treated infective endocarditis: a nationwide cohort study

## TL;DR

This study examines the outcomes of reimplanting cardiac devices in patients with infective endocarditis who had their devices removed, finding no significant difference in recovery between those who were reimplanted and those who were not.

## Contribution

The study provides new insights into the timing and outcomes of reimplanting cardiac devices in patients with infective endocarditis.

## Key findings

- 60% of patients had their cardiac devices reimplanted within three months after extraction.
- No significant differences in mortality or recurrent infection were found between reimplanted and non-reimplanted patients.

## Abstract

Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) is associated with morbidity and mortality. Current guidelines recommend complete CIED extraction; however, the optimal timing for reimplantation remains uncertain. We aimed to evaluate CIED reimplantation rates, and outcomes in patients with non-surgically treated IE who underwent CIED extraction.

We included all Danish residents ≥18 years diagnosed with first-time IE (2010–2021), with a pre-existing CIED, who underwent CIED extraction without concurrent valve surgery. Data were obtained from Danish nationwide registries. The primary variable of interest was CIED reimplantation within 90 days after extraction. Reimplantation rates were described, and reimplantation status was used to stratify patients for analysis of secondary outcomes, including recurrent IE-related bacteraemia and all-cause mortality within 6 months. Among 661 patients with CIED extraction due to IE, 396 (59.9%) underwent reimplantation within 3 months, with a median of 29 days (IQR:19–42 days). There was no significant difference in the 6 month cumulative incidence of recurrent bacteraemia with IE (2.5% [95% CI:0.95–5.5] vs. 1.8% [95% CI:0.8–3.6] P = 0.55) or mortality (11.2% [95% CI:7.0–16.4] vs. 7.0% [95% CI:4.7–10.0]; P = 0.11) between non-reimplanted and reimplanted patients.

In IE patients who underwent CIED extraction, 60% of patients were reimplanted within 3 months with substantial variation in timing. No significant differences in outcomes were found by reimplantation status.

Graphical Abstract