Temporal Trends in Utilization of Transvenous Lead Extractions among Patients with Cardiac Implantable Electronic Device Infections: Analyses of the Nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination data
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Background
Cardiac implantable electronic device (CIED) infections are a growing concern, leading to significant morbidity and mortality. International guidelines recommend a complete device and lead extraction for infected cases, yet real-world adherence to these recommendations remains suboptimal. The utilization of transvenous lead extractions (TLEs) in Japan has not been well characterized.
Methods
We conducted a retrospective observational study using the Japanese Registry of All Cardiac and Vascular Diseases diagnosis procedure combination/per diem payment system (JROAD-DPC) from 2015 to 2021. Patients diagnosed with CIED infections were identified based on the International Classification of Diseases, 10th revision codes. This study aimed to investigate the real-world utilization of TLEs in CIED infections, assess the trends over time, and identify the factors associated with the likelihood of undergoing a TLE and the procedural complications.
Results
Among 7,434 hospitalization records, only 38% underwent TLEs for CIED infections in the overall hospitals. However, the utilization of TLEs in certified TLE hospitals increased significantly from 54.0% in 2015 to 70.8% in 2021 (p-trend < 0.001). Independent predictors of reduced TLEs included a lower BMI, female sex, cerebrovascular disease, and dementia. Notably, 65.5% of patients in non-certified hospitals were discharged home, suggesting potential undertreatment.
Conclusions
While the TLE rate is increasing, a considerable proportion of patients with CIED infections do not undergo TLEs. Addressing barriers through physician education, improved referral systems, and adherence to guideline-directed management, especially in non-certified hospitals, is essential for optimizing the TLE rate.
Clinical Perspectives
What Is New?
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This study was the first nationwide, population-based analysis to evaluate the actual rate and trends of transvenous lead extractions (TLEs) for cardiac implantable electronic device (CIED) infections in Japan.
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By rigorously identifying clinically indicated cases based on the current guidelines, it revealed a marked increase in TLE implementation, particularly in certified hospitals, and also highlighted a substantial undertreatment in non-certified centers.
What Are the Clinical Implications?
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Despite increasing TLE rates, especially in certified hospitals, a significant proportion of patients with clinically indicated CIED infections do not undergo lead extractions.
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Identifying the predictors of undertreatment and reinforcing education and referral pathways in non-certified hospitals are essential steps to ensure a timely and appropriate guideline-directed management.
