Low Utilization of Lead Extraction in Endocarditis Patients with Implantable Cardiac Devices: A Call to Arms

A new study has revealed that relatively few infective endocarditis patients with implanted cardiac devices have their leads extracted as recommended, despite low complication rates. The study showed that transvenous lead extraction occurred in just 11.5% of patients with cardiac implantable electronic devices (CIEDs) admitted with endocarditis. This proportion increased significantly over time but remained low. The alarmingly low rates raise serious concerns about the management of such patients in real-world clinical practice and should be a call to arms for the field. Lead extraction is vital in the case of CIED-related endocarditis, and any strategy that does not target complete removal of leads and lead material qualifies as suboptimal care. Given the lower mortality in patients with CIEDs and infective endocarditis treated with lead extraction, it is crucial to investigate barriers to extraction. Physicians must recognize CIED-related infections and make early referrals.