{
  "abstract": "Background Current guidelines recommend complete removal of a cardiac implantable electronic device (CIED) in patients with infective endocarditis (IE), although these recommendations are largely based on expert opinion (level of evidence C). We aimed to examine outcomes stratified by CIED removal status in patients with IE.Methods Using Danish nationwide registries (2010–2021), we identified patients aged ≥18 years with first-time IE, who were alive at discharge, managed without valve surgery and had a CIED. Patients who underwent CIED removal during IE admission were compared with those without removal. The study outcomes were IE readmission, recurrent bacteraemia (including IE with the same microbial aetiology) and all-cause mortality within 6 months after discharge.Results The study population comprised 1040 patients with non-surgically managed IE and a CIED, and among these, 596 (57.3%) underwent CIED removal during admission. Patients who underwent removal were younger and less frail than those without removal. In the removal versus non-removal group, the 6-month cumulative incidences were 2.5% (95% CI 1.4% to 4.1%) vs 7.1% (95% CI 4.9% to 9.9%) for IE readmission (p value <0.001), 2.1% (95% CI 1.1% to 3.5%) vs 5.2% (95% CI 3.4% to 7.6%) for recurrent bacteraemia (p value=0.005) and 11.5% (95% CI 9.1% to 14.3%) vs 20.0% (95% CI 16.4% to 23.9%) for all-cause mortality (p value <0.001). In multivariable Cox regression models, CIED removal was associated with lower 6-month rates of IE readmission (HR 0.39 (95% CI 0.19 to 0.79)) and all-cause mortality (HR 0.70 (95% CI 0.49 to 0.996)), compared with no removal.Conclusions In this nationwide study of patients with non-surgically managed IE and a CIED, CIED removal was associated with significantly lower 6-month rates of IE readmission, recurrent bacteraemia and mortality compared with no removal, supporting current guideline recommendations. However, randomised clinical trials are warranted to determine the most effective treatment strategy.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Amna Alhakak"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Lauge Østergaard"
    },
    {
      "affiliations": [
        "Department of Cardiology, Zealand University Hospital – Roskilde, Roskilde, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Niels Eske Bruun"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Cardiology, Zealand University Hospital – Roskilde, Roskilde, Denmark"
      ],
      "name": "Anne-Christine Ruwald"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Berit Thornvig Philbert"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Michael Vinther"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark"
      ],
      "name": "Peter Godsk Jørgensen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Cardiology, Zealand University Hospital – Roskilde, Roskilde, Denmark"
      ],
      "name": "Eva Havers-Borgersen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Zealand University Hospital – Roskilde, Roskilde, Denmark"
      ],
      "name": "Kasper Høtoft Bengtsen"
    },
    {
      "affiliations": [
        "Department of Veterinary and Animal Sciences, Section of Pathobiological Sciences, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Louise Kruse Jensen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Jonas Agerlund Povlsen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark",
        "Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"
      ],
      "name": "Jens Cosedis Nielsen"
    },
    {
      "affiliations": [
        "Department of Cardiology, Odense University Hospital, Odense, Denmark"
      ],
      "name": "Jens Brock Johansen"
    },
    {
      "affiliations": [
        "Department of Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark"
      ],
      "name": "Marianne Voldstedlund"
    },
    {
      "affiliations": [
        "Department of Clinical Microbiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Claus Moser"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Henning Bundgaard"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Lars Køber"
    },
    {
      "affiliations": [
        "Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Emil Loldrup Fosbøl"
    }
  ],
  "title": "Practice patterns and outcomes of cardiac implantable electronic device removal in patients with non-surgically managed infective endocarditis",
  "uid": "4c6fc47a-43d6-5c97-b445-a5aadd5ba92d"
}