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.