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Article

Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs

1
The Chaim Sheba Medical Center, Leviev Heart Institute, Tel Hashomer, Ramat Gan 5262000, Israel
2
School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5450; https://doi.org/10.3390/jcm14155450 (registering DOI)
Submission received: 5 July 2025 / Revised: 20 July 2025 / Accepted: 31 July 2025 / Published: 2 August 2025
(This article belongs to the Section Cardiology)

Abstract

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM implantation without increasing infection risks. Our objective is to evaluate the safety and cost-effectiveness of LP implantation during the same procedure of CIED extraction, compared to conventional two-stage approaches. Methods: Pacemaker-dependent patients with systemic or pocket infection undergoing device extraction and LP implantation during the same procedure at Sheba Medical Center, Israel, were compared to a historical group of patients undergoing a semi-permanent (SP) pacemaker implantation during the procedure, followed by a permanent pacemaker implantation. Results: The cohort included 87 patients, 45 undergoing LP implantation and 42 SP implantation during the extraction procedure. The LP group demonstrated shorter intensive care unit stay (1 ± 3 days vs. 7 ± 12 days, p < 0.001) and overall hospital days (11 ± 24 days vs. 17 ± 17 days, p < 0.001). Rates of infection relapse and one-year mortality were comparable between groups. Economic analysis revealed comparable total costs, despite the higher initial expense of LPs. Conclusions: LP implantation during CIED extraction offers significant clinical and logistical advantages, including reduced hospital stays and streamlined treatment, with comparable safety and cost-effectiveness to conventional approaches.
Keywords: leadless pacemaker; extraction; cardiac implantable electronic device; infection leadless pacemaker; extraction; cardiac implantable electronic device; infection

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MDPI and ACS Style

Solomon, A.; Tzuberi, M.; Berkovitch, A.; Hoch, E.; Beinart, R.; Nof, E. Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs. J. Clin. Med. 2025, 14, 5450. https://doi.org/10.3390/jcm14155450

AMA Style

Solomon A, Tzuberi M, Berkovitch A, Hoch E, Beinart R, Nof E. Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs. Journal of Clinical Medicine. 2025; 14(15):5450. https://doi.org/10.3390/jcm14155450

Chicago/Turabian Style

Solomon, Aviv, Maor Tzuberi, Anat Berkovitch, Eran Hoch, Roy Beinart, and Eyal Nof. 2025. "Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs" Journal of Clinical Medicine 14, no. 15: 5450. https://doi.org/10.3390/jcm14155450

APA Style

Solomon, A., Tzuberi, M., Berkovitch, A., Hoch, E., Beinart, R., & Nof, E. (2025). Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs. Journal of Clinical Medicine, 14(15), 5450. https://doi.org/10.3390/jcm14155450

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