Prevalence and risk factors related to infections of cardiac resynchronization therapy devices

Romeyer‐Bouchard, Cécile; Costa, Antoine Da; Dauphinot, Virginie; Messier, Marc; Bisch, Laurence; Bernard, Samuel; Lafond, Patrick; Ricci, Piera; Isaaz, Karl

doi:10.1093/eurheartj/ehp421

Cited by 136 publications

(136 citation statements)

References 41 publications

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“…However, our results suggest that the ICD may be more cost-effective in primary prevention in young male CRT patients with ischemic cardiomyopathy who are on stable NYHA class III despite optimal medical treatment and have few comorbidities, while the cost-effectiveness ratio of routine CRT-D implantation (compared with CRT-P) in elderly patients or those with mild heart failure may be less attractive. Considering that CRT-D associates with a higher risk of complications 44,55,56 and a significantly higher cost compared with CRT-P, our results reinforce the importance of selecting the right patient for the procedure and suggest that providing every CRT candidate with an ICD is unlikely to be clinically beneficial or costeffective.…”

Section: Discussionsupporting

confidence: 60%

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Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

et al. 2017

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Section: Discussionsupporting

confidence: 60%

“…As such, the addition of the ICD may in theory provide incremental protection. Nevertheless, this comes at the expense of an increased risk of device-related complications 44,55,56 and significantly higher cost; therefore this question merits careful scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

et al. 2017

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“…19,21,24 In a large, Danish cohort study, number of prior CIED procedures was strongly associated with a higher infection risk (see Figure 2). 18 Careful CIED prescription is important to avoid early need for system upgrade, and should include estimation of left ventricular function prior to implantation.…”

Section: Re-operationmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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“…20 Procedure-related factors include procedure time, temporary pacemaker use prior to implantation, early re-intervention and postoperative haematoma at the device pocket site. 21 ICD replacement is associated with a 2.5x greater incidence of pocket-related events, and the need for re-intervention increases with every consecutive replacement. 10 A registry study found that PPM and ICD generator replacements were associated with a substantial complication risk, particularly those with lead additions.…”

mentioning

confidence: 99%

Cardiac Implantable Electronic Device Infection in Patients at Risk

Tarakji

Ellis

Defaye

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Device TherapyOver the last few decades an increasing body of evidence has supported the role of cardiovascular implantable electronic devices However, the cost and complications of device implantation, including infection or hardware malfunction in patients receiving CIEDs, have led to the concern that negative outcomes may partially counteract the expected benefits. The rate of CIED infection has been estimated at 0.5 % with primary implants and 1-7 % with secondary interventions.3,5-8 It is difficult to give accurate estimates of infection rates, given the fact that figures are partly based on retrospective series of varying duration, and that different definitions of infection exist. However, the incidence of CIED infection is increasing out of proportion to CIED implantation. 3,5,9 A US study reported a 12 % increase in the number of CIED implantations from 2004 to 2006, with a 57 % increment in CIED infections during the same period. 9Reasons for this rise in CIED infections include the fact that younger patients are receiving CIEDs, and therefore surviving long enough to require more pulse generator changes and lead revisions, which are associated with a higher infection rate. 7,10 In addition, there has been an increase in comorbidities, such as diabetes and kidney disease, resulting in poor wound healing and diminished immune responses. 3,9,11,12 Expanding indications for CIED use, coupled with an ageing population with more comorbidities, mean this trend is likely to increase.2 Better awareness and improved reporting of CIED infections may, however, help to decrease the higher complication rates noted in recent years.CIED infections also impose a substantial financial burden resulting from prolonged hospital stays, long duration of antibiotic therapy, management of sepsis and complications, device extraction and reimplantation.3 These infections typically cost at least $52,000 13 and may exceed $100,000. 14 This article will review strategies for management and prevention of CIED infections, including lead extraction and the use of an absorbable antibacterial envelope. Risk Factors for Cardiac Implantable Electronic Device Infections

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Prevalence and risk factors related to infections of cardiac resynchronization therapy devices

Cited by 136 publications

References 41 publications

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Cardiac Implantable Electronic Device Infection in Patients at Risk

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