Factors related to the skin thickness of cardiovascular implantable electronic device pockets

Abstract

Introduction:The skin overlying cardiovascular implantable electronic devices (CIEDs) sometimes becomes very thin after implantations, which could cause a device erosion. The factors related to the skin thickness of device pockets have not been elucidated. This study aimed to evaluate the skin thickness of CIED pockets and search for the factors associated with the thickness.Methods: Seventeen skin thickness points around the CIED pocket were measured through ultrasonography in each patient.Results: A total of 101 patients (76 ± 11 years, 26 female) were enrolled. The median duration from the implantation to the examination was 95 months (quartile: 52.5-147.5). The median skin thickness overlying the device was 4.1 mm (3.3-5.9).Patients with heart failure and malignancy had thinner skin overlying the CIED than those without. A significant correlation existed between skin thickness and body mass index (BMI), hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction. In contrast, age, gender, and device size did not exhibit a significant correlation with skin thickness. A multivariate logistic regression analysis revealed that chronic heart failure and a decrease in the eGFR and BMI were independent predictive factors of "very thin (≦3.3 mm)" skin of the CIED pocket late after an implantation. Conclusion:Aside from a low BMI, the comorbidities (low hemoglobin, heart failure, and renal dysfunction) had a stronger impact on the skin thickness overlying the device than the device size. A careful observation of the device pocket should be performed in patients with those risk factors.

Risk of skin erosion and local pocket infections in population of patients with cardiac implantable electronic devices undergoing transvenous lead extraction

“…The most frequently considered are as follows: improper CIED implantation or reimplantation with too shallow design of the pocket and progressive weight loss (cachexia), but it can also be the temporary first visible stage or even the first symptom of CIED pocket infection 1,2 . In the observation of Yatomi et al, 3 risk factors for skin thinning over the generator were low body mass index, low hemoglobin level, heart failure, malignancy, and renal dysfunction. In this study, a retrospective analysis of clinical data from a group of 101 patients with an average lead dwell time of 95 months revealed no cases of pocket infections in patients with thinning of the skin over the generator.…”

“…Previous studies based on small populations confirm the presence of early contamination of the pocket with a tendency to subsequent colonization and development of full-blown infection. 6,7 It seems that in patients with a shallow pocket, the infectious process may begin early after implantation and proceed covertly; therefore, presented by Yatomi et al, 3 the concept of measuring skin thinning over the generator can be a form of detailed control of patients particularly at risk of developing infectious complications.…”