Neoplasms arising at the CIED pocket: a hybrid study combining a case report, scoping review, and clinical survey

Cardiac implantable electronic device (CIED) implantation is a minor surgical procedure, with a low complication incidence. Neoplasm occurrence at the CIED pocket is a rare event, and sporadic cases are reported without a comprehensive evaluation. This hybrid study aims to fill this gap through a three-part approach: a new case report, a scoping review with individual patient data (IPD) analysis, and a clinical survey. In March 2024, a male patient with a history of high-grade urothelial cancer referred to our Department with a mass at the CIED pocket. Incisional biopsy confirmed the diagnosis of high-grade urothelial carcinoma. The patient died after 4 months. Through our scoping review and IPD analysis, we collected 56 patients affected by primary neoplasms [40 (71.4%)] and metastasis [16 (28.6%)] at the CIED pocket. Among the primary neoplasms, adenocarcinoma (12; 30.0%) was most frequent in females, while sarcoma (10; 25.0%) was predominant in males. On the other hand, metastasis types were represented by breast cancer (3; 18.8%) in females, and myeloma (2; 13.3%) and melanoma (2; 13.3%) in males. The clinical survey showed data from 471 patients who underwent CIED implantation. No primary neoplasm or metastasis developed at the CIED pocket, also in subjects with history of cancer. Although rare, both primary and metastatic neoplasms may occur at the site of CIED implantation. Vigilant monitoring of CIED patients is essential, particularly when changes at the pocket site arise. Early biopsy and oncologic assessment should be considered in such cases to enable timely diagnosis and intervention.