Background: Early re-intervention may increase the risk of infection of cardiac implantable electronic devices (CIED). Some operators therefore delay lead repositioning in case of dislocation by weeks, however there is no evidence to support this practice. The aim of our study was to evaluate the impact of the timing of re-operation on infection risk.

Methods: Data from consecutive patients (n=300) receiving lead/generator repositioning in one Hungarian and one German tertiary centre between January 1995 and June 2021 were retrospectively analysed. Relative risk of CIED infection in the first year was compared among patients undergoing early (≤1 week) vs. delayed re-operation.

Results: Out of 300 patients, 235 patients (mean age 70 ± 14 years, 53% male) required CIED re-intervention (27% single-chamber, 49% dual-chamber, and 21% CRT devices) either for right atrial (n=49, 21%), right ventricular (n=142, 60%), coronary sinus (n=16, 7%), or multiple lead (n=27, 12%) repositioning in the first year after the primary implantation. Eighty-one patients (34%) underwent early and 154 (66%) patients delayed lead/pocket revision within a median time of 52±72 days. A total of 9 (4%) wound/device infections were identified during the first year of follow-up with consecutive system explantation/extraction in 7 cases (3%), all being revised in the delayed group. There was no statistically significant difference in the rate of infection between the early and delayed intervention groups (OR=0.23; 95% CI 0.03-2.07; p=0.17). After adjustment for typical risk factors for CIED infection (i.e. number of implanted leads, diabetes, fever prior implant, therapy with corticosteroids, anticoagulation therapy, temporary pacemaker therapy) this difference remained non-significant (OR=0,29; 95% C. I. 0.04-2.39; p=0.25).

Conclusion: In this bicentric study, delayed re-intervention did not reduced the risk of CIED infection compared to patients undergoing an early (<1 week) re-operation.