Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center

Carretero, Encarnación Gutiérrez; Arana‐Rueda, Eduardo; Cabezas, José Manuel; Martínez, Fernando Laviana; Gil-Ortega, Manuel Villa; Martínez, Juan Acosta; Martínez, A. Pedrote; González, Arístides de Alarcón

doi:10.1016/j.rec.2016.09.031

Cited by 6 publications

(7 citation statements)

References 28 publications

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“…However, in our own experience [ 16 ], the rate of clinical failure with these local approaches is unacceptable, resulting in a plethora of new problems [ 17 , 18 ] and thus increasing the costs of the procedures. The aim of this study was to analyze the costs of these CIED-related infections, considering the efficacy of the different techniques and the costs associated with each approach.…”

Section: Introductionmentioning

confidence: 99%

Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study

Gutiérrez-Carretero,

Arana-Rueda,

Ortiz-Carrellán

et al. 2024

Microorganisms

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Background: Cardiac device infections are serious adverse events associated with considerable morbidity and mortality, significant costs, and increased healthcare utilization. The aim of this study is to calculate the costs of treatment of cardiac implantable electrostimulation device (CIED)-related infections for different types of infection (local or systemic) and therapeutic approaches. Patients and Methods: Single-center cohort (1985–2018). The costs of the CIED-related infections were analyzed according to initial treatment (antimicrobial treatment exclusively, local approach, or transvenous lead extraction (TLE)). Total costs (including those for hospitalization stay, drugs, extraction material, and newly implanted devices) were assigned to each case until its final resolution. Results: A total of 380 cases (233 local and 147 systemic infections) were analyzed. The average cost of systemic infection was EUR 34,086, mainly due to hospitalization (78.5%; mean: 24 ± 14 days), with a mortality rate of 10.8%. Local infection had a mortality rate of 2.5% (mainly related to the extraction procedure) and an average cost of EUR 21,790, which was higher in patients with resynchronization therapy devices and defibrillators (46% of total costs). Surgical procedures limited to the pocket for local infections resulted in a high rate of recurrence (87%), evolved to systemic infections in 48 patients, and had a higher cost compared to TLE (EUR 42,978 vs. EUR 24,699; p < 0.01). Conclusions: The costs of treating CIED-related infections are high and mainly related to the type of treatment and length of hospitalization. Complete device removal is always the most effective approach and is a cost-saving strategy.

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Section: Introductionmentioning

confidence: 99%

Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study

Gutiérrez-Carretero,

Arana-Rueda,

Ortiz-Carrellán

et al. 2024

Microorganisms

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“…Current guidelines recommend explantation and reimplanting a fresh generator device after the control of infection. 7 However, removal of the CIEDs, especially the leads, is also fraught with danger with potentially fatal complications and additional cost 8 .Many investigators have attempted salvage by treating the pocket infection surrounding the CIED, changing the generator device and relocation into a new subcutaneous pocket without removal of atrioventricular (AV) leads. 9 10 11 12 As explanting CIEDs is an expensive proposition, there is a felt need of salvaging infected CIEDs.…”

Section: Introductionmentioning

confidence: 99%

Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

Chatterjee

Sharma

Pratap

et al. 2021

Indian J Plast Surg

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Introduction Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. Aim To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Material and Methods Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Results Twelve patients (m = 10; f = 2) with a mean age of 65 years (range, 46–82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8–30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. Conclusion In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.

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“…Several studies have also shown that the more complex the device, the higher the incidence of infection . Finally, CIED infection can be easy to diagnose and manage in some cases, but in others a high degree of vigilance is required, and it is desirable to have a standardized definition of infection and a multidisciplinary approach that can be lacking in retrospective series . For all of these reasons, the current rate of infection in the ICD population is probably underestimated and not well understood, with rates varying between 1% and 9.5% in different series, depending on the type of ICD and the duration of follow‐up …”

Section: Introductionmentioning

confidence: 99%

Repeated procedures at the generator pocket are a determinant of implantable cardioverter‐defibrillator infection

Arana‐Rueda

Pedrote

Frutos‐López

et al. 2017

Clinical Cardiology

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Background Rates of cardiac‐device infections have increased in recent years, but the current incidence and risk factors for infection in patients with implantable cardioverter‐defibrillators (ICDs) are not well known. Hypothesis The increasing number of ICD infections is related to accumulated pocket manipulations over time. Methods This single‐center, prospective study included patients that underwent ICD implantation from 2008 to 2015. The endpoint was time to infection. Multivariate analysis was performed to identify independent risk factors related to infection. Results The study included a total of 570 patients, of whom 419 (73.5%) underwent a first implantation. Mean age was 59 ± 14 years, and 80% were male. During a median follow‐up of 36 months (interquartile range, 18–61 months; 1887 patient‐years), infection was identified in 26 patients (4.56%), an incidence of 14.9 × 1000 patient‐years. Median time to infection was 9.7 months (interquartile range, 1.35–23.4 months), and 38.5% were late infections (beyond 12 months of follow‐up). In patients with replacement implants, the incidence was 3‐fold higher than in first implantations (27.7 vs 9.1 × 1000 patient‐years; P = 0.002). Cox regression identified 2 independent predictors of ICD infection: cumulative number of interventions at the generator pocket (hazard ratio: 1.92, 95% confidence interval: 1.42‐2.6, P < 0.001) and pocket hematoma (hazard ratio: 7.0, 95% confidence interval: 2.7‐17.9, P < 0.0001). Conclusions The incidence of infection in ICD patients is greater than previously reported, largely due to late infections. Each new cumulative intervention at the same generator pocket nearly doubles the risk of infection.

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Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center

Cited by 6 publications

References 28 publications

Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study

Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study

Salvage of Infected Cardiac Implantable Electrical Devices with Subpectoral Plane Pocket Revision

Repeated procedures at the generator pocket are a determinant of implantable cardioverter‐defibrillator infection

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