External implantable defibrillator as a bridge to reimplant after explant for infection: Experience from two centers

Abstract

Background: The management of patients explanted for implantable converter defibrillator (ICD) infections may be complex when anti-bradycardia pacing and tachyarrhythmia protection are needed. We aimed to test the efficacy and safety of a conventional ICD externally connected to a transvenous dual-coil lead as bridging therapy before the reimplantation.

Methods and results: We enrolled seven patients explanted for ICD infections and needed prolonged antibiotic therapy in two high-volume hospitals in Italy and treated them with a passive-can external ICD for a mean of 13 (4-30) days before reimplant. One patient experienced an electrical storm, efficaciously recognized by the external ICD and treated with antitachycardia pacing and shocks. On-demand pacing was granted for all the patients. No device-related complications were reported.

Conclusions: An external ICD seems safe and efficacious as a bridge to reimplant in patients explanted for ICD infections.

Keywords: device infection; implantable cardioverter defibrillator; implantable defibrillator infection; transvenous lead extraction.