Treatment and Prevention of Cardiovascular Implantable Electronic Device (CIED) Infections

Phillips, Peter; Krahn, Andrew D.; Andrade, Jason G.; Chakrabarti, Santabhanu; Thompson, Christopher; Harris, David J.; Forman, Jacqueline M.; Karim, Shahzad S.; Sterns, Laurence D.; Fedoruk, Lynn M.; Partlow, Eric; Bashir, Jamil

doi:10.1016/j.cjco.2022.07.010

Cited by 13 publications

(17 citation statements)

References 79 publications

(202 reference statements)

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“…The latter might be preferred, especially in a high-risk population for cardiac implantable electronic device (CIED) infections, such as CKD patients, in which lesser time of indwelling leads and reduced number of generator replacements gained by delaying a PPM implantation might be beneficial. 12 The absence of signal for increased risk of a "wait and see" approach in the prolonged follow-up of our series, as seen in previous studies, further supports this approach. 5,6,8,9. Alternatively, a leadless pacing system can be considered in this patient population as it has been seldom associated with CIED infections.…”

Section: Discussionsupporting

confidence: 84%

“…Such a consideration warrants a change in approach to patients with AVB and these transient factors in that there should be either a lower bar for offering a PPM at the index event, or a close follow‐up to assess the appropriate timing for elective PPM implantation. The latter might be preferred, especially in a high‐risk population for cardiac implantable electronic device (CIED) infections, such as CKD patients, in which lesser time of indwelling leads and reduced number of generator replacements gained by delaying a PPM implantation might be beneficial 12 . The absence of signal for increased risk of a “wait and see” approach in the prolonged follow‐up of our series, as seen in previous studies, further supports this approach 5,6,8,9 .…”

Section: Discussionsupporting

confidence: 78%

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Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Santos,

Martinho,

Ferreira

et al. 2024

Pacing Clinical Electrophis

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BackgroundAtrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long‐term recurrence are lacking.MethodsPatients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis.ResultsIn a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2–47.5 (p = .03)); greater serum potassium levels (OR 2.3; CI 95% 1.28–4.0 (p < .01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13–4.4 (p = .02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02–40.3 (p < .01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8–15.1 (p < .01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19–1.5 (p = .23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow‐up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm.ConclusionsRecovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow‐up warrants a close follow‐up or PPM implantation at index admission.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 78%

Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Santos,

Martinho,

Ferreira

et al. 2024

Pacing Clinical Electrophis

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“…Since the removal or extraction of cardiovascular implantable electronic device (CIED) is usually mandated if infection occurs 2 . However, there is a dispute about the optimal timing of device reimplantation following the infected CIED extraction 3 . Current practice standards support waiting between 72 h and 14 days before reimplanting a device 4 …”

Section: Discussionmentioning

confidence: 99%

“…2 However, there is a dispute about the optimal timing of device reimplantation following the infected CIED extraction. 3 Current practice standards support waiting between 72 h and 14 days before reimplanting a device. 4 For patients with pacemaker indications, a new pacemaker needs to be re-implanted, and this process has many risks, such as reinfection and venous approach occlusion.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous transvenous lead extraction and implantation of leadless cardiac pacemaker: A case report

2023

Clinical Case Reports

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Cardiovascular implantable electronic device (CIED) infection is a serious complication and remains the most common indication for transvenous lead extraction (TLE). In addition, there are serious challenges such as venous access occlusion and reinfection after extraction. Leadless pacemaker (LP) provides a safe and effective pacing option for patients with device‐related infections. We describe here a case of simultaneous transvenous lead extraction and leadless pacemaker implantation due to bilateral venous infection and pacing dependency.

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“…Every year, more than 1 million patients affected by cardiac rhythm disorders receive a cardiac implantable electronic device (CIED) in Europe and North America alone. [1][2][3] Although the benefits of device therapy largely outweigh risks in eligible patients, short-term and long-term complications represent a problem even in established treatments, such as transvenous permanent pacing, for which published 60-day and 3-year adverse event rates in new implants reach 12.4% and 18.3%, respectively. 4,5 Evidence shows that events are often underreported in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters

Mascheroni,

Stockburger,

Patwala

et al. 2023

JAMA Netw Open

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ImportanceIn cardiac device implant training, there is no common system to objectively assess trainees’ ability to perform tasks at predetermined performance levels before in vivo practice; therefore, patients are potentially exposed to risks related to operators’ early learning curve.ObjectiveTo assess the effect on implant performance quality of novel metrics-based simulation training to proficiency (proficiency-based progression [PBP]) vs traditional simulation-based training (SBT).Design, Setting, and ParticipantsIn this prospective randomized trial, conducted between March 8, 2022 and November 24, 2022, novice implanters were randomized (blinded) 1:1 to participate in an SBT curriculum (procedural knowledge e-learning and in-person simulation training) at an international skills training center, with proficiency demonstration requirements at each training stage for advancing (PBP approach) or without the requirements. Ultimately, trainees performed a cardiac resynchronization therapy (CRT) implant using virtual reality simulation. The procedure was video-recorded and subsequently scored using previously validated metrics by 2 independent assessors blinded to group. Physicians who had already implanted more than 20 pacemakers or defibrillators and fewer than 200 CRT systems as the first operator were eligible. Thirty-two implanters from 10 countries voluntarily enrolled in the training program and were randomized; 30 (15 per group) started and completed training. Data analysis was performed from November 27 to December 22, 2022.InterventionTraining with PBP vs SBT.Main Outcome and MeasuresThe primary outcome comprised 4 objectively assessed performance metrics derived from the video-recordings: number of procedural steps completed, errors, critical errors, and all errors combined.ResultsBaseline experience of the 30 participants (19 [63%] male; mean [SD] number of years in implant practice, 2.0 [1.8]; median [IQR] number of implanted pacemakers or defibrillators, 47.5 [30.0-115.0]; median [IQR] number of implanted CRT systems, 3.0 [1.25-10.0]) was similar between study groups. Compared with the SBT group, the PBP group completed 27% more procedural steps (median [IQR], 31 [30-32] vs 24 [22-27]; P &lt; .001) and made 73% fewer errors (median [IQR], 2 [1-3] vs 7 [5-8]; P &lt; .001), 84% fewer critical errors (median [IQR], 1 [0-1] vs 3 [3-5]; P &lt; .001), and 77% fewer all errors combined (errors plus critical errors) (median [IQR], 3 [1-3] vs 11 [8-12]; P &lt; .001); 14 of the 15 PBP trainees (93%) demonstrated the predefined target performance level vs 0 of the 15 SBT trainees.Conclusions and RelevanceIn this randomized trial, the PBP approach to novice implanter training generated superior objectively assessed performance vs SBT. If implemented broadly and systematically, PBP training may ensure safe and effective performance standards before trainees proceed to (supervised) in vivo practice. Future studies are needed to verify implications on procedure-related patient complications.Trial RegistrationClinicalTrials.gov Identifier: NCT05952908

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Treatment and Prevention of Cardiovascular Implantable Electronic Device (CIED) Infections

Cited by 13 publications

References 79 publications

Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Simultaneous transvenous lead extraction and implantation of leadless cardiac pacemaker: A case report

Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters

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