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Outcomes of Chlorhexidine Scrubbing without Capsulectomy vs. Complete Capsulectomy After Lead Extraction for the Treatment of Cardiac Implantable Device Infection
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  • Juan Carlos Diaz,
  • Jorge Marin,
  • Julian Aristizabal,
  • Oriana Bastidas,
  • Carolina Hoyos,
  • Carlos Matos,
  • Nestor Lopez-Cabanillas,
  • Jose Matias,
  • Luigi DiBiase,
  • Jorge Romero,
  • Cesar Niño,
  • Estefania Rivera,
  • Joan Rodriguez-Taveras,
  • Juan Manuel Martinez,
  • Juanita Velásquez,
  • Isabella Alviz,
  • Mauricio Duque
Juan Carlos Diaz
Clinica Las Vegas

Corresponding Author:jcdiaz1234@hotmail.com

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Jorge Marin
Clinica Las Vegas
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Julian Aristizabal
Clinica Las Vegas
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Oriana Bastidas
Clinica Las Vegas
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Carolina Hoyos
Brigham and Women's Hospital
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Carlos Matos
Brigham and Women's Hospital
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Nestor Lopez-Cabanillas
Instituto Cardiovascular de Buenos Aires
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Jose Matias
Montefiore Medical Center
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Luigi DiBiase
Montefiore Medical Center
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Jorge Romero
Brigham and Women's Hospital
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Cesar Niño
Clinica Las Vegas
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Estefania Rivera
Brigham and Women's Hospital
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Joan Rodriguez-Taveras
Boston Medical Center
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Juan Manuel Martinez
Clinica Las Vegas
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Juanita Velásquez
Clinica Las Vegas
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Isabella Alviz
Montefiore Medical Center
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Mauricio Duque
Clinica Las Vegas
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Abstract

Introduction: Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time-consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) scrubbing in lieu of capsulectomy for the treatment of CIED infections. Methods: This retrospective observational study included patients who underwent TLE for CIED-related infections. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, thorough scrubbing of the generator pocket with 20 cc of 2% CHG followed by irrigation with approximately 500 cc of sterile normal saline (SNS) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included any adverse reaction to chlorhexidine, the need for reintervention, infection-related mortality, and total procedural time. Results: A total of 102 patients (mean age 67.2±13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n=54) or CHG (n=48) scrubbing. Hematoma formation was significantly higher in the capsulectomy group vs. the CHG group (13% vs. 0%, p=0.014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7±78.5vs. 89.9±51.8 minutes, p=0.002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: 3 in the capsulectomy group and 1 in the CHG group (p=0.346). Conclusions: In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.
07 Nov 2022Submitted to Journal of Cardiovascular Electrophysiology
07 Nov 2022Submission Checks Completed
07 Nov 2022Assigned to Editor
07 Nov 2022Review(s) Completed, Editorial Evaluation Pending
10 Nov 2022Reviewer(s) Assigned
09 Jan 2023Editorial Decision: Revise Minor
12 Jan 20231st Revision Received
19 Jan 2023Review(s) Completed, Editorial Evaluation Pending
19 Jan 2023Submission Checks Completed
19 Jan 2023Assigned to Editor
19 Jan 2023Reviewer(s) Assigned
07 Feb 2023Editorial Decision: Accept