Temporal Trends in Utilization of Transvenous Lead Extractions Among Cardiac Implantable Electronic Device Infections.

BACKGROUND: Cardiac implantable electronic device (CIED) infections are a growing concern, leading to significant morbidity and mortality. International guidelines recommend complete device and lead extraction for infected cases, yet real-world adherence to these recommendations remains suboptimal. The use of transvenous lead extraction (TLE) in Japan has not been well characterized. OBJECTIVES: This study aimed to investigate the real-world use of TLE in CIED infections, assess trends over time, and identify factors associated with the likelihood of undergoing TLE and the procedural complications. METHODS: This was 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 with a diagnosis of CIED infections were identified on the basis of the International Classification of Diseases, 10th revision codes. RESULTS: Among 7,434 hospitalization records, only 38% underwent TLE for CIED infections in the overall hospitals. However, the use of TLE in certified TLE hospitals increased significantly from 54.0% in 2015 to 70.8% in 2021 (P trend <0.001). Independent predictors of reduced TLE use included a lower body mass index, female sex, cerebrovascular disease, and dementia. Notably, 65.5% of patients in noncertified hospitals were discharged home, a finding suggesting potential undertreatment. CONCLUSIONS: Although the TLE rate is increasing, many patients with CIED infections do not undergo TLE. Addressing barriers through physician education, improved referral systems, and adherence to guideline-directed management, especially in noncertified hospitals, is essential for optimizing the TLE rate.