Outcomes of Chlorhexidine Scrubbing without Capsulectomy vs. Complete
Capsulectomy After Lead Extraction for the Treatment of Cardiac
Implantable Device Infection
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.