Lead vegetations in patients with local and systemic cardiac device infections: prevalence, risk factors and therapeutic effects

Introduction. Actual rates of lead vegetations (LV) in cardiovascular device infections (CDI) are debated. Aims. To characterize prevalence and risk factors of LV in patients with CDI treated with lead extraction (LE). Methods. Between 2003 and 2011, 293 leads were extracted from 136 patients (age 70.5±14.5 years, 109 males) with infective indications: 39.2% chronic draining sinus, 20.9% pocket infections and 28.8% systemic infections/sepsis. All patients underwent TEE before LE. Results. LV prevalence was 40.4%: 62.2% in systemic infection, but noteworthy in local infection/chronic draining sinus (21.9/36.4%). Younger age, renal disease and dialysis were associated with systemic infection. Fever after last intervention, revision, previous reparative procedure, infection at wound/device site and infection > 6 months were associated with local infection/chronic draining sinus. CRT device, fever after last intervention, infection < 6 months, renal disease, dialysis, abnormal chest X-Ray, fever at admission, pulmonary symptoms, WBC, ESR, CRP increase and positive blood samples were related to LV. Risk of vegetations was reduced by antibiotic prophylaxis. Multivariate analysis indicated that renal failure and increased WBC were related to LV. Conclusion LV were frequently observed in patients with only local symptoms. Therefore, TEE should be mandatory in all patients undergoing LE for infective indications.