Management and Outcomes of Cardiac Implantable Electronic Device Infections without Specialized Lead Extraction Tools in a Resource-Limited Setting: A Single-Center Retrospective Study

Abstract

Objectives: To evaluate management strategies and clinical outcomes of patients with CIED infections treated without specialized lead extraction tools in a resource-limited tertiary care setting. Methodology: This single-center retrospective study included patients admitted with CIED infection at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, between June 2023 and October 2025. Patients were categorized according to management strategy: Group 1 (no complete hardware removal) and Group 2 (complete hardware removal). Follow-up was conducted through outpatient clinic visits and structured telephone interviews. Clinical outcomes included procedural success, in-hospital mortality, infection persistence, recurrence, and follow-up mortality. Results: A total of 53 patients were analyzed (mean age 58.2 ± 17.2 years; 56.6% male). Complete hardware removal was achieved in 37 patients (69.8%), while 16 patients (30.2%) underwent partial removal or debridement only. Of 99 indwelling leads, 71 (71.7%) were successfully extracted using manual traction techniques. Median dwell time of explanted leads was 136 days [19–1198]. In-hospital mortality occurred in 3 patients (5.6%). During follow-up (median 173 days), persistence of infection occurred in 4 patients (8.5%), and recurrence was observed in 3 patients (6.4%). Infection persistence was significantly more frequent in patients without complete hardware removal. Conclusion: In this resource-limited setting, complete hardware removal was feasible in approximately two-thirds of CIED infections without specialized extraction tools and was associated with lower infection persistence. While outcomes appear acceptable, findings should be interpreted cautiously given the retrospective design and limited sample size.