Device-related infective endocarditis in cardiac resynchronization therapy recipients — Single center registry with over 2500 person-years follow up

Jędrzejczyk-Patej, Ewa; Mazurek, Michał; Kowalski, Oskar; Sokal, Adam; Kozieł, Monika; Adamczyk, Karolina; Przybylska-Siedlecka, Katarzyna; Morawski, Stanisław; Liberska, Agnieszka; Szulik, Mariola; Podolecki, Tomasz; Kowalczyk, Jacek; Kalarus, Zbigniew; Lenarczyk, Radosław

doi:10.1016/j.ijcard.2016.11.029

Cited by 19 publications

(17 citation statements)

References 32 publications

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“…As reported previously, mortality rates in patients with CRT and CDRIE are very high and may reach 50% during index hospitalisation [11]. In a longer perspective and considering a larger patient population, we report herein in-hospital and long-term mortality rates of 51.2% and 75.6%, respectively.…”

Section: Discussionsupporting

confidence: 68%

Outcomes in patients undergoing cardiac resynchronisation therapy complicated by device-related infective endocarditis

et al. 2018

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A b s t r a c tBackground: Cardiac device-related infective endocarditis (CDRIE) is one of the most serious complications of cardiac resynchronisation therapy (CRT). Aim:We sought to assess clinical outcomes and their determinants in CRT patients with CDRIE. Methods:A tertiary cardiology centre database was screened to identify all CDRIE cases, diagnosed based on the modified Duke criteria, amongst 765 consecutive CRT implantations performed between 2002 and 2015 (70.8% de novo implantations, 29.2% upgrades). Results:During the median follow-up of 1692 days (range: 457-3067 days) CDRIE was diagnosed in 41 (5.4%) patients. Overall, in-hospital and long-term mortality rates of CDRIE patients were 51.2% and 75.6%, respectively. Among patients with CDRIE, in whom the device was vs. was not explanted, in-hospital death rates were 39.3% (11/28 patients) vs. 76.9% (10/13 patients; p = 0.025). In multivariate regression analysis, device removal was independently associated with significantly lower in-hospital mortality (hazard ratio [HR] 0.09, 95% confidence interval [CI] 0.03-0.35, p = 0.0004). The need for temporary pacing after device removal (HR 5.92, 95% CI 1.13-30.96, p = 0.035), a time period of less than seven days between CDRIE diagnosis and CRT removal (HR 6.69, 95% CI 1.48-30.27, p = 0.01), and the highest serum creatinine level during infection (HR 1.02, 95% CI 1.004-1.03, p = 0.01) were identified as independent predictors of higher in-hospital mortality. Conclusions:Device removal is independently associated with lower mortality in patients with CRT and CDRIE. Early device removal (less than seven days since the diagnosis), the need for temporary pacing after removal and acute renal failure are independent mortality predictors in CRT patients who developed CDRIE.

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Section: Discussionsupporting

confidence: 68%

Outcomes in patients undergoing cardiac resynchronisation therapy complicated by device-related infective endocarditis

et al. 2018

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“…The role of the implantable cardioverter-defibrillator (ICD) in reducing the rate of sudden cardiac death (SCD) in patients at risk of life-threatening ventricular tachyarrhythmias has been demonstrated in numerous clinical trials [1,2]. Despite recent developments in technology, device-related complications, especially those connected with transvenous leads, are frequent and are associated with significant morbidity and mortality [3][4][5]. The purpose of developing an entirely subcutaneous ICD (S-ICD) was to avoid endocardial leads, and thus to eliminate the risk of lead-related complications.…”

Section: Introductionmentioning

confidence: 99%

Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: a sub-study of the European Heart Rhythm Association prospective survey

et al. 2018

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“…As we have reported previously, CDRIE develops in almost 5% of CRT recipients within 3.5 years after implantation and is associated with a very poor prognosis with mortality rates exceeding 65% [5]. Thus, an early diagnosis of this life-threatening condition along with "aggressive" treatment seem to be crucial for a positive outcome.…”

Section: B Amentioning

confidence: 69%

“…The study design, factors influencing CDRIE development and outcomes in CRT recipients with CDRIE have been published previously [5]. In this analysis we sought to investigate the clinical picture of CRT-related endocarditis and to identify various pathogens associated with the disease development.…”

Section: Study Populationmentioning

confidence: 99%

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Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients

et al. 2021

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The aim of the study was to analyse microbiological characteristics and clinical manifestations of cardiac device-related infective endocarditis (CDRIE) in cardiac resynchronization therapy (CRT) recipients, and to compare the diagnostic value of modified Duke (MDC) versus modified Duke lead criteria (MDLC; including to MDC local infection and pulmonary infection or embolism as major criteria). Material and methods: The study population comprised 765 consecutive CRT patients from a high-volume, tertiary care centre from 2002 to 2015. All patients were screened for CDRIE. Results: During a median follow-up of 1692 days (range: 457-3067) 5.36% of patients (n = 41) developed CDRIE, which was accompanied by CRT pocket infection in 17.1% (n = 7) and recurrent pulmonary infection or pulmonary embolism in 29.3% (n = 12). Fever was present in 95.1% of patients (n = 39), whereas blood cultures were positive in 65.9% (n = 27). Staphylococcus was the most prevalent pathogen in 59.3% (n = 16), Gram-negative bacteria in 25.9% (n = 7). Transoesophageal echocardiography showed intracardiac vegetations in 73.2% of patients (n = 30). Non-different pathogen types with the most common methicillin-sensitive Staphylococcus aureus were observed for early versus late CDRIE (endocarditis ≤ 6 vs. > 6 months from CRT or other device-related procedure). All 3 inflammatory markers (C-reactive protein, white blood cells, procalcitonin) were normal in 4.9% of patients (n = 2). MDC versus MDLC indicated definite CDRIE in 48.8% versus 80.5%, respectively (p = 0.003). Conclusions: Fever is the most common symptom of CRT-related CDRIE, and transoesophageal echocardiography allows vegetations to be visualised in nearly 3/4 of patients with CDRIE. Although the most common pathogens were Staphylococci, Gram-negative bacteria accounted for a quarter of CDRIE. Modified Duke lead criteria proved superior to MDC.

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Device-related infective endocarditis in cardiac resynchronization therapy recipients — Single center registry with over 2500 person-years follow up

Cited by 19 publications

References 32 publications

Outcomes in patients undergoing cardiac resynchronisation therapy complicated by device-related infective endocarditis

Outcomes in patients undergoing cardiac resynchronisation therapy complicated by device-related infective endocarditis

Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: a sub-study of the European Heart Rhythm Association prospective survey

Clinical manifestations of device-related infective endocarditis in cardiac resynchronization therapy recipients

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