Simultaneous LP implantation and TLE procedure
In our series, there was one patient who underwent a simultaneous LP implantation and PM removal during the same procedure. Beurskens et al. recently reported a case series of 17 patients who underwent a simultaneous TLE and LP implantation procedure in the setting of an active infection. 13 They demonstrated either the safety or the freedom from recurrent infections during a mean follow‐up of 16 months. Kypta et al. also presented two cases in a small series in whom a Micra implant was safe and feasible even though the implant had been performed before the removal of an infected PM system within the same procedure. 14 Furthermore, a subanalysis of the Micra post-approval registry demonstrated that among 105 patients with prior device infections, 39 (37.1%) received a Micra implant on the day of the TLE procedure. 15 This strategy has the benefit of avoiding temporary pacing leads as a bridge to a permanent PM implantation. A previous study reported that temporary transvenous leads are associated with maintaining and causing a recurrence of device infections with an odds ratio of 2.5.10 It can also avoid the risk of self-removing their temporary pacing leads in patients with severe dementia. However, there are some concerns about performing TLEs and LP implants on the same day, since the current evidence about the outcome of this approach seems relatively weak to guarantee the safety in a population at high risk of a reinfection. Therefore, prospective randomized data on the LP therapy in the management of device infections are required to determine the optimal timing and recovery window to perform an LP implantation after extractions of infected PMs.