Infectious complications in patients with cardiac implantable electronic devices – risk factors, prevention and prognosis

Abstract

597has been rising due to an increasing number of ICD or CRT device implantations in a specif ic population of patients with severe heart fail ure (HF) and comorbidities. Furthermore, re cent years have witnessed a tremendous increase in average life expectancy, which translates into a higher number of reinterventions (generator re placement, system upgrade) in patients receiving CIEDs. 2-6 A significant increase in the incidence INTRODUCTION Cardiac implantable electron ic device (CIED) infections, which develop in pa tients with pacemakers, implantable cardiovert er-defibrillators (ICDs), and cardiac resynchro nization therapy (CRT) devices, pose a major clinical challenge. The incidence of these infec tions is estimated to range from 1% to 2% in pa tients with CIEDs.1 However, these data are inac curate because the incidence of CIED infections OBJECTIVES The aim of this study was to assess the risk factors and long term survival of patients with CIED infections. PATIENTS AND METHODSWe analyzed the clinical data of 1837 patients (including xx [40.9%] patients with CIED infections), who underwent transvenous lead extraction at a single institution between 2006 and 2015. We compared the clinical and procedure related factors for all types of CIED infections: iso lated pocket infection (IPI), isolated lead related infective endocarditis (ILRIE), and lead related infective endocarditis with coexisting pocket infection (LRIE + PI). We also analyzed long term survival rates. RESULTSThe development of IPI and LRIE + PI depended mainly on age, male sex, number of leads, presence of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT D), and the number of previous procedures. The factors that determined ILRIE included chronic renal failure (CRF), ICD/CRT D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against the development of infection. Long term survival was significantly related to age, heart failure, diabetes mellitus, CRF, malignancy, and chronic atrial fibrillation.CONCLUSIONS The development of all types of CIED infection was associated mainly with procedure related factors, while long term mortality was dependent on clinical factors. The dissimilarity of factors affecting the development of IPI and ILRIE confirms that there are 2 variants of CIED infection. The pro tective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in the prevention of CIED infection.

Ten-year study of late electrotherapy complications. Single-centre analysis of indications and safety of transvenous leads extraction

“…This concept has been confirmed in the current study; the important factors in the risk of infections associated with PM/ICD/CRT were the number of CIED-related procedures preceding TLE, and a greater number of implanted leads, especially superfluous and abandoned ones in patients with LRIE. Such results have been reported in studies based on large populations of patients undergoing TLE [16,17].…”

Risk factors for cardiac device-related infection during two-year follow-up: a retrospective analysis

“…Well-documented risk factors for CDIs comprise the number of CIED-related procedures in a single patient [2,5] and the complexity of these procedures [6][7][8]. In our analysis, the history of an upgrade of a CIED system was associated with a fourfold increase in the risk of future TLE due to CDI, which is in accordance with other reports [5].…”

Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction

“…This is not unexpected. In fact, after inoculation of bacteria in animals with catheters in the heart, grossly visible vegetation was prevented by the administration of anticoagulants [28], and anticoagulant treatment protected against the development of infection in a large retrospective study of 1837 patients [29]. On the basis of our findings, anticoagulation should be promptly instituted in order to reduce the vegetation mass size but only after an effective antibiotic treatment has been initiated.…”