Chapter 10 172 The PADIT (Prevention of Arrhythmia Device Infection Trial) score was developed to predict the risk of hospitalisation for device infection within 1 year (35, 36). This model includes 5 independent predictors of CIED infection including number of Prior procedures, Age, Depressed renal function (estimated glomerular filtration rate [GFR] <30 mL/min), being Immunocompromised, and procedure Type. The minimum risk score is 0 and the maximum is 13. Based on the PADIT-score, 3 risk categories can be identified: low risk (≤4), intermediate risk (5-6), and high risk (≥7) of hospitalisation for device infection within 1 year (35). Antibacterial envelopes may cost effectively be used in high-risk patients as the WRAP-IT trial has demonstrated (37). In the Netherlands reimbursement is currently lacking, further underlining the need for properly identifying high risk patients. To evaluate the risk in every day clinical practice we performed a retrospective single-center study of consecutive patients undergoing a CIED procedure (chapter 6) (38). We evaluated hospitalisation for a CIED infection in the first year after the index procedure between January 2016 and November 2021. Patients who received an antibacterial envelope were excluded from this study. The primary endpoint was hospitalisation for a CIED infection in the first year after the procedure. A total of 2333 CIED procedures were performed in the study period, with a CIED infection occurring in 10 patients (0.43%). In predicting major CIED infection the PADIT-score had a good discrimination. The risk of CIED infection was higher in the patients with a PADIT score of ≥7 compared to those with a lower PADIT-score. Based on these results, we concluded that the PADIT-score is a clinically useful score for identifying patients at risk of developing CIED infection. The use of an antibacterial envelope in these high-risk patients may be cost-effective. When CIED-related infection occurs, there is a class I indication for transvenous lead extraction (TLE). TLE is also used in case of dysfunctional leads or in upgrade procedures when venous access is limited. TLE tools have evolved, and the most common tools are a mechanical or laser extraction sheath and the use of snares. In general, the femoral snare has mainly been used as a bail-out procedure. In chapter 7 we evaluated the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach between 2012 till 2019 (39). A total of 264 procedures were performed in the study period. The main indications for TLE were mostly lead malfunction, but also isolated pocket infection and systemic
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