1. OUTCOMES OF INFECTED CARDIAC DEVICES REMOVED BY LASER LEAD EXTRACTION BACKGROUND Sparse evidence exists to describe the appropriate management of infected cardiac devices (implantable defibrillators and permanent pacemakers). To date there is no description of a cohort managed with complete removal of all hardware using laser lead sheath extraction in all cases of suspected infection, intraoperative transesophageal echocardiogram, and a uniform antimicrobial approach. The purpose of this study was to describe clinical outcomes in a cohort managed in such a fashion. These included hospital mortality, device re-infection rates (defined as a new infection with a different organism or infection with the same organism over 90 days beyond device extraction) and device infection relapse rates (defined as recurrence of infection with the same organism within 90 days of device extraction). RESULTS There were 171 subjects in the cohort who underwent device extraction for an infectious indication with culture and follow-up data available. These were categorized as in the table below to distinguish pocket site infections from deep infections (positive lead or vegetation cultures), with and without METHODS We retrospectively reviewed a cohort of 288 consecutive subjects referred for laser lead extraction of a cardiac device at our institution between 1/2004 - 12/2007. Subjects were classified based on findings during echocardiography, device removal, and culture data. Post extraction antimicrobial exposure was calculated and clinical outcomes were recorded. bacteremia. A total of 12 subjects (7%) died during the index hospitalization, though only 3 (1.7%) of these deaths were attributable to the initial infection or the device extraction procedure. The overall rate of re-infection/relapse was 1.2% with a mean follow-up period of 27.8 months. A single subject experienced a relapse of infection from the deep infection with bacteremia category. A re-infection occurred beyond 90 days in the deep infection category. CONCLUSION Management of cardiac device associated infections with full hardware removal using laser lead extraction, along with uniform antimicrobial therapy, resulted in attributable hospital mortality and re-infection/relapse rates of less than 2% . This is the largest body of data revealing low mortality and re-infection outcomes when such a combined modality approach is applied to infected cardiac devices. Alexander D. Griffin, MD 1 , Roger G. Carrillo, MD 1 , Joseph C. Chan, MD 2 1 University of Miami, Miami, Fl, 2 Mount Sinai Medical Center, Miami, Fl. CLINICAL OUTCOMES BY DEVICE INFECTION CATEGORY Type of Infection Number Average days of Post Extraction Antibiotic Therapy Hospital Mortality Hospital Mortality attributable to initial infection or extraction Re-Infection or Relapse Pocket Infection (Positive Tissue or Exudate Cultures) 28 11.7 0 (0%) 0 (0%) 0 (0%) Deep Infection (Positive lead or vegetation cultures) 90 21.4 4 (4.4%) 1 (1.1%) 1 (1.1%) Deep infection and Bacteremia 53 26.8 8 (15.1%) 2 (3.8%) 1 (1.9%) Total 171 21.5 12 (7.0%) 3 (1.7%) 2 (1.2%)