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Lacharite-Roberge AS, Toomu S, Aldaas O, Ho G, Pollema TL, Birgersdotter-Green U. Inflammatory biomarkers as predictors of systemic vs isolated pocket infection in patients undergoing transvenous lead extraction. Heart Rhythm O2 2024; 5:289-293. [PMID: 38840769 PMCID: PMC11148492 DOI: 10.1016/j.hroo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Cardiovascular implantable electronic device (CIED) infections are a common indication for device extraction. Early diagnosis and complete system removal are crucial to reduce morbidity and mortality. The lack of clear infectious symptoms makes the diagnosis of pocket infections challenging and may delay referral for extraction. Objective We aimed to determine if inflammatory biomarkers can help diagnose CIED isolated pocket infection. Methods We performed a retrospective analysis of all patients undergoing transvenous lead extraction for CIED infection at the University of California San Diego from 2012 to 2022 (N = 156). Patients were classified as systemic infection (n = 88) or isolated pocket infection (n = 68). Prospectively collected preoperative procalcitonin (PCT), C-reactive protein, and white blood cell count were compared between groups. Results Pairwise comparisons revealed that the systemic infection group had a higher PCT than the control group (P < .001) and the pocket infection group (P = .009). However, there was no significant difference in PCT value between control subjects and isolated pocket infection subjects. Higher white blood cell count was only associated with systemic infection when compared with our control group (P = .018). Conclusion In patients diagnosed with CIED infections requiring extraction, inflammatory biomarkers were not elevated in isolated pocket infection. Inflammatory markers are not predictive of the diagnosis of pocket infections, which ultimately requires a high level of clinical suspicion.
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Affiliation(s)
- Anne-Sophie Lacharite-Roberge
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Sandeep Toomu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Omar Aldaas
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Gordon Ho
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Travis L. Pollema
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego, San Diego, California
| | - Ulrika Birgersdotter-Green
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
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Han HC, Hawkins NM, Pearman CM, Birnie DH, Krahn AD. Epidemiology of cardiac implantable electronic device infections: incidence and risk factors. Europace 2021; 23:iv3-iv10. [PMID: 34051086 PMCID: PMC8221051 DOI: 10.1093/europace/euab042] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Cardiac implantable electronic device (CIED) infection is a potentially devastating complication of CIED procedures, causing significant morbidity and mortality for patients. Of all CIED complications, infection has the greatest impact on mortality, requirement for re-intervention and additional hospital treatment days. Based on large prospective studies, the infection rate at 12-months after a CIED procedure is approximately 1%. The risk of CIED infection may be related to several factors which should be considered with regards to risk minimization. These include technical factors, patient factors, and periprocedural factors. Technical factors include the number of leads and size of generator, the absolute number of interventions which have been performed for the patient, and the operative approach. Patient factors include various non-modifiable underlying comorbidities and potentially modifiable transient conditions. Procedural factors include both peri-operative and post-operative factors. The contemporary PADIT score, derived from a large cohort of CIED patients, is useful for the prediction of infection risk. In this review, we summarize the key information regarding epidemiology, incidence and risk factors for CIED infection.
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Affiliation(s)
- Hui-Chen Han
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles M Pearman
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester M13 9XX, UK
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Implant Fibrosis and the Underappreciated Role of Myofibroblasts in the Foreign Body Reaction. Cells 2021; 10:cells10071794. [PMID: 34359963 PMCID: PMC8304203 DOI: 10.3390/cells10071794] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Body implants and implantable medical devices have dramatically improved and prolonged the life of countless patients. However, our body repair mechanisms have evolved to isolate, reject, or destroy any object that is recognized as foreign to the organism and inevitably mounts a foreign body reaction (FBR). Depending on its severity and chronicity, the FBR can impair implant performance or create severe clinical complications that will require surgical removal and/or replacement of the faulty device. The number of review articles discussing the FBR seems to be proportional to the number of different implant materials and clinical applications and one wonders, what else is there to tell? We will here take the position of a fibrosis researcher (which, coincidentally, we are) to elaborate similarities and differences between the FBR, normal wound healing, and chronic healing conditions that result in the development of peri-implant fibrosis. After giving credit to macrophages in the inflammatory phase of the FBR, we will mainly focus on the activation of fibroblastic cells into matrix-producing and highly contractile myofibroblasts. While fibrosis has been discussed to be a consequence of the disturbed and chronic inflammatory milieu in the FBR, direct activation of myofibroblasts at the implant surface is less commonly considered. Thus, we will provide a perspective how physical properties of the implant surface control myofibroblast actions and accumulation of stiff scar tissue. Because formation of scar tissue at the surface and around implant materials is a major reason for device failure and extraction surgeries, providing implant surfaces with myofibroblast-suppressing features is a first step to enhance implant acceptance and functional lifetime. Alternative therapeutic targets are elements of the myofibroblast mechanotransduction and contractile machinery and we will end with a brief overview on such targets that are considered for the treatment of other organ fibroses.
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Maciel ADS, Silva RMFLD. Clinical Profile and Outcome of Patients with Cardiac Implantable Electronic Device-Related Infection. Arq Bras Cardiol 2021; 116:1080-1088. [PMID: 33825793 PMCID: PMC8288527 DOI: 10.36660/abc.20190546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)
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Chohan AJ, Hawkins BM, Rousan TA, Milton MA, Velazco-Davila LD, Reynolds DW, Sivaram CA. TEE-Guided Percutaneous Aspiration of a Large Lead-Associated Vegetation Prior to Transvenous Lead Extraction. CASE (PHILADELPHIA, PA.) 2021; 5:16-19. [PMID: 33644508 PMCID: PMC7887444 DOI: 10.1016/j.case.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vacuum-assisted aspiration of large CIED lead vegetations is a promising technology. TEE guidance is critical for the safe and complete aspiration of vegetations. Real-time TEE identifies important residual findings following lead extraction.
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Affiliation(s)
- Amad J Chohan
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Talla A Rousan
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mark A Milton
- Ascension Medical Group St. John Heart Rhythm Services, Tulsa, Oklahoma
| | | | - Dwight W Reynolds
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chittur A Sivaram
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Vasilev S. Strategies for Prevention of Surgical Site Infection in Patients With CIED Implantation: A Literature Review. Cureus 2021; 13:e13021. [PMID: 33542887 PMCID: PMC7849920 DOI: 10.7759/cureus.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In the last several years a stable increase in cardiovascular implantable electronic device (CIED) implantation has been seen, mainly because of the expanded indications for their usage. An important complication of CIED implantation is possible postprocedural infection (pocket or systemic), which is connected with high morbidity and mortality rates and carries a significant financial cost to the health systems. Although this complication is not that frequent (ranging from 1% to over 5% in different studies), it is associated with a significant burden to patients, clinicians, and the healthcare system and because of that attention should be placed on the prevention of the infection. In this article, we collected and summarized the information and data available, directly related to the problem of prevention of CIED infection. The results of different studies and guidelines, regarding prevention with antibiotics, antiseptics, and the usage of antibacterial envelopes are analyzed. Perspective is put on the new technology of using antibacterial envelopes for prevention of infections. The aim of this paper is to review the various infection prevention techniques and to highlight the most beneficial ones according to guidelines and worldwide studies.
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Sławek-Szmyt S, Araszkiewicz A, Grygier M, Szmyt K, Chmielewska-Michalak L, Seniuk W, Waśniewski M, Smukowski T, Lesiak M, Mitkowski P. Predictors of Long-Term Infections After Cardiac Implantable Electronic Device Surgery ― Utility of Novel PADIT and PACE DRAP Scores ―. Circ J 2020; 84:1754-1763. [DOI: 10.1253/circj.cj-20-0305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | - Krzysztof Szmyt
- Department of General, Endocrine and Gastrointestinal Oncology Surgery, Poznan University of Medical Sciences
| | | | - Wojciech Seniuk
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | | | - Tomasz Smukowski
- 1st Department of Cardiology, Poznan University of Medical Sciences
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences
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Holcman K, Rubiś P, Ząbek A, Ćmiel B, Szot W, Boczar K, Wiśniowska-Śmiałek S, Stępień A, Małecka B, Podolec P, Kostkiewicz M. The Prognostic Value of 99mTc-HMPAO-Labeled Leucocyte SPECT/CT in Cardiac Device-Related Infective Endocarditis. JACC Cardiovasc Imaging 2020; 13:1739-1751. [DOI: 10.1016/j.jcmg.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/08/2023]
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Goldenberg GR, Barsheshet A, Bishara J, Kadmon E, Omelchencko A, Strasberg B, Golovchiner G. Effect of fibrotic capsule debridement during generator replacement on cardiac implantable electronic device infection risk. J Interv Card Electrophysiol 2019; 58:113-118. [PMID: 31227978 DOI: 10.1007/s10840-019-00581-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) replacement is increasingly common. It has been proposed that capsule removal at the time of CIED replacement may reduce infection rates. In this study, we aimed to assess how pocket capsule removal impacted infection rates in patients undergoing CIED replacement. METHODS We retrospectively reviewed the medical records of patients who underwent CIED replacement from 2006 to 2016 at a single centre. We retrieved patient data, procedure details, and clinical outcomes. To evaluate the relationship between capsule removal and CIED infection, we used the Cox proportional hazard model, with adjustment for multiple variables. RESULTS During the study period, 773 patients underwent device replacement. Of these patients, 194 (25%) underwent capsule debridement during the replacement procedure. The mean patient age was 75 ± 15 years, and 281 (36.3%) were females. The replaced CIEDs included DDD pacemakers (32%), VDD pacemakers (15%), VVI/AAI pacemakers (13%), defibrillators (22%), and cardiac resynchronization therapy devices (CRT-D/P) (17%). During an average follow-up of 3.6 years, 42 (5%) patients experienced a CIED infection. Multivariate analysis revealed that patients who underwent capsule removal had a significantly lower risk of CIED infection, with a hazard ratio of 0.32 (95% confidence interval, 0.12-0.83; P = 0.019). CONCLUSIONS Capsule debridement during CIED replacement was associated with a significant reduction of CIED infection risk. There is a need for randomized controlled studies to confirm these findings.
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Affiliation(s)
- Gustavo R Goldenberg
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Alon Barsheshet
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Infectious Diseases Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Ehud Kadmon
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Alex Omelchencko
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Boris Strasberg
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gregory Golovchiner
- Electrophysiology and Pacing Unit, Department of Cardiology, Rabin Medical Center, Ze'ev Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Østergaard L, Valeur N, Wang A, Bundgaard H, Aslam M, Gislason G, Torp-Pedersen C, Bruun NE, Søndergaard L, Køber L, Fosbøl EL. Incidence of infective endocarditis in patients considered at moderate risk. Eur Heart J 2018; 40:1355-1361. [DOI: 10.1093/eurheartj/ehy629] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/01/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lauge Østergaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Henning Bundgaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Mohsin Aslam
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Roskilde University Hospital, Roskilde, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Lars Søndergaard
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Lars Køber
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
| | - Emil Loldrup Fosbøl
- Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark
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11
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Korantzopoulos P, Plakoutsi S, Florou E, Bechlioulis A. Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series. Pacing Clin Electrophysiol 2018; 41:897-901. [PMID: 29785752 DOI: 10.1111/pace.13378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/18/2018] [Accepted: 05/07/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The early and correct diagnosis of cardiac implantable electronic device (CIED) infections is critical given that early aggressive treatment with complete removal of the system along with antimicrobial therapy dramatically improves outcomes. Pocket infection manifested by local signs of inflammation is the most common form of CIED infections. Conditions mimicking pocket infection have been described in the literature. These include various types of malignancy and rarely allergic reactions/contact dermatitis to pacemaker compounds. We aimed to describe skin lesions and disorders over the pocket area that mimic CIED infection. METHODS We present a series of five cases with skin lesions that mimic pocket infection. We document these cases with corresponding photographs. Most of them have not been described in this setting. RESULTS We report the following cases of conditions that proved not to be CIED infection: One case of superficial cellulitis, one case of herpes zoster over the pocket area, one case of spontaneous bruising over the pocket a long time after implantation in a patient taking oral anticoagulation, and two cases of contact dermatitis due to prolonged postoperative application of povidone-iodine. All cases had favorable outcome after conservative treatment and no CIED infection was developed during follow-up. CONCLUSION Clinicians should be aware of rare conditions that mimic CIED infection. Incorrect diagnosis of these disorders may falsely lead to CIED extraction.
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Affiliation(s)
- Panagiotis Korantzopoulos
- First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece.,Arrhythmia Device and Electrophysiology Laboratory, University Hospital of Ioannina, Ioannina, Greece
| | - Sofia Plakoutsi
- Arrhythmia Device and Electrophysiology Laboratory, University Hospital of Ioannina, Ioannina, Greece
| | - Elizabeth Florou
- Arrhythmia Device and Electrophysiology Laboratory, University Hospital of Ioannina, Ioannina, Greece
| | - Aris Bechlioulis
- Arrhythmia Device and Electrophysiology Laboratory, University Hospital of Ioannina, Ioannina, Greece.,Second Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
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12
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Menezes Júnior ADS, Magalhães TR, Morais ADOA. Percutaneous Lead Extraction in Infection of Cardiac Implantable Electronic Devices: a Systematic Review. Braz J Cardiovasc Surg 2018; 33:194-202. [PMID: 29898151 PMCID: PMC5985848 DOI: 10.21470/1678-9741-2017-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/22/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections. METHODS A systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently. RESULTS Sixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up. CONCLUSION Percutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.
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Affiliation(s)
- Antônio da Silva Menezes Júnior
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | - Thaís Rodrigues Magalhães
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
| | - Alana de Oliveira Alarcão Morais
- Escola de Ciências Médicas, Farmacêuticas e Biomédicas of the Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil
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13
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Peacock JE, Stafford JM, Le K, Sohail MR, Baddour LM, Prutkin JM, Danik SB, Vikram HR, Hernandez-Meneses M, Miró JM, Blank E, Naber CK, Carrillo RG, Greenspon AJ, Tseng CH, Uslan DZ. Attempted salvage of infected cardiovascular implantable electronic devices: Are there clinical factors that predict success? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018. [PMID: 29518265 DOI: 10.1111/pace.13319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. METHODS Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. RESULTS Of 433 adult patients with CIED infections, 306 (71%) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29%). "Early failure" of attempted salvage occurred in 74 patients (58%) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42%) in the attempted salvage group retained their CIED. Twenty-six (49%) had resolution of CIED infection (successful salvage group) whereas 27 patients (51%) experienced "late" salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. CONCLUSIONS In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal.
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Affiliation(s)
- James E Peacock
- Section on Infectious Diseases, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeanette M Stafford
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine Le
- Division of Infectious Diseases, Department of Medicine, and the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Muhammad Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, and the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, and the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jordan M Prutkin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Stephan B Danik
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Holenarasipur R Vikram
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Marta Hernandez-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Elisabeth Blank
- Ärztin im Studienzentrum Kardiologie, Contilia Heart and Vascular Center, Essen, Germany
| | - Christoph K Naber
- Klinik für Kardiologie und Angiologie, Contilia Heart- and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
| | - Roger G Carrillo
- Cardiothoracic Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Arnold J Greenspon
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Daniel Z Uslan
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, CA, USA
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Beijerink NJ, Bergmann W, Szatmári V. Incomplete endothelialization of an intravascular implant and fatal late-onset bacterial ductal arteritis in a dog with occluded patent ductus arteriosus. J Vet Intern Med 2018. [PMID: 29524349 PMCID: PMC5980296 DOI: 10.1111/jvim.15074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An 18‐month‐old male Akita Inu dog developed fever and lameness 8 months after successful transcatheter closure of a patent ductus arteriosus with an Amplatz Canine Duct Occluder (ACDO). Corynebacterium species were cultured from 3 blood samples. Echocardiography showed a vegetative process on the aortic valves. The dog died spontaneously 3 days after development of the initial signs. Necropsy confirmed the presence of bacterial ductal arteritis and myocarditis, and revealed an incomplete endothelialization of the intraductal metal implant. The reason for the lack of (neo)endothelialization of the ACDO remains unknown. We conclude that late‐onset bacterial device‐related ductal arteritis can develop in dogs where the implant is incompletely covered by a protective endothelial layer.
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Affiliation(s)
- Niek Jozef Beijerink
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | | | - Viktor Szatmári
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
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Abstract
BACKGROUND AND OBJECTIVES Due to the widespread indications for device implants and the population aging, right-sided infective endocarditis (RSIE) epidemiology has dramatically changed, being nowadays, cardiac device carriers the main affected group. The aim of this work is to describe the epidemiology, clinical profile and outcomes of RSIE in cardiac device carriers. PATIENTS AND METHODS We included definitive infective endocarditis episodes consecutively diagnosed in 3 tertiary centers from March 1995 to September 2014. A retrospective analysis of 85 variables, one-year follow up and univariate analysis of in-hospital mortality was conducted. RESULTS Among 1,182 episodes, 100 cardiac device carriers presented with RSIE (8.5%). Mean age±SD was 67±14 years. Staphylococcus spp. were the main causative microorganisms (coagulase-negative 44%, aureus 31%) and 37% were methicillin-resistant. Cardiac devices were removed in 95% of patients. In-hospital mortality was 8% and one-year mortality was 4%. Univariate analysis demonstrated that renal failure at admission (OR 6.2; 95% CI 1.3-30.3), septic shock (OR 8.9; 95% CI 1.7-47.9) and persistent infection during clinical course (OR 19.4; 95% CI 3-125.7) increase in-hospital mortality while device removal is a protective factor (OR 0.08; 95% CI 0.02-0.39). CONCLUSIONS RSIE have low in-hospital and one-year mortality. Coagulase-negative Staphylococci is responsible of almost half of the episodes and methicillin-resistant incidence is high. Device removal is mandatory since it decreases in-hospital mortality.
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Bhatia M, Safavi-Naeini P, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management of Laser Lead Extraction for Cardiovascular Implantable Electronic Devices. Semin Cardiothorac Vasc Anesth 2017; 21:302-311. [DOI: 10.1177/1089253217728581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) play a significant role in the modern management of cardiovascular disease. CIEDs include implantable pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. These devices improve the quality of life of their recipients and help reduce the incidence of sudden cardiac death. Traditionally, CIEDs have been reliant on the use of transvenous endocardial leads to directly connect with the heart. Over time, these endovascular leads may become endothelialized rendering removal extremely difficult. As the indications for CIEDs expands and with the continuing evolution of these devices, the number of patients requiring explantation for device recall, malfunction, and infection continues to increase. In this manuscript, we review the most common CIEDs, the indications and process of lead removal/device explantation, potential complications associated with the procedure and the anesthetic management of these patients.
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Affiliation(s)
- Meena Bhatia
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics. Vet Microbiol 2017; 207:25-28. [DOI: 10.1016/j.vetmic.2017.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022]
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Biomarker-based diagnosis of pacemaker and implantable cardioverter defibrillator pocket infections: A prospective, multicentre, case-control evaluation. PLoS One 2017; 12:e0172384. [PMID: 28264059 PMCID: PMC5338770 DOI: 10.1371/journal.pone.0172384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background The use of cardiac implantable electronic devices (CIED) has risen steadily, yet the rate of cardiac device infections (CDI) has disproportionately increased. Amongst all cardiac device infections, the pocket infection is the most challenging diagnosis. Therefore, we aimed to improve diagnosis of such pocket infection by identifying relevant biomarkers. Methods We enrolled 25 consecutive patients with invasively and microbiologically confirmed pocket infection. None of the patients had any confounding conditions. Pre-operative levels of 14 biomarkers were compared in infected and control (n = 50) patients. Our selected biomarkers included white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), lipopolysaccharide binding protein, high-sensitivity C-reactive protein (HS-CRP), polymorphonuclear-elastase, presepsin, various interleukins, tumor necrosis factor α (TNF-α), and granulocyte macrophage colony-stimulating factor (GM-CSF). Results Of the 25 patients with isolated pocket infection (70±13years, 76% male, 40% ICDs), none presented with leukocytosis. In contrast, they had higher serum levels of HS-CRP (p = 0.019) and PCT (p = 0.010) than control patients. Median PCT-level was 0.06 ng/mL (IQR 0.03–0.07 ng/mL) in the study group versus 0.03 ng/mL (IQR 0.02–0.04 ng/mL) in controls. An optimized PCT cut-off value of 0.05 ng/mL suggests pocket infection with a sensitivity of 60% and specificity of 82%. In addition TNF-α- and GM-CSF-levels were lower in the study group. Other biomarkers did not differ between groups. Conclusion Diagnosis of isolated pocket infections requires clinical awareness, physical examination, evaluation of blood cultures and echocardiography assessment. Nevertheless, measurement of PCT- and HS-CRP-levels can aid diagnosis. However, no conclusion can be drawn from normal WBC-values. Clinical trial registration clinicaltrials.gov identifier: NCT01619267
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Green R, Cantoni V, Nappi C, Gaudieri V, Zampella E, Assante R, Acampa W. Radionuclide Imaging of Cardiac Device Infection. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9406-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Bautista Vargas WF, Rodriguez Guerrero DA, Sáenz LC. Uso de los sistemas de presión negativa en el tratamiento de infecciones asociadas a dispositivos: “una vieja terapia con un uso novedoso”. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Manolis AS, Melita H. Managing infected cardiovascular implantable electronic devices. ACTA ACUST UNITED AC 2016. [DOI: 10.1002/cce2.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - H. Melita
- Onassis Cardiac Surgery Center; Athens Greece
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Bongiorni MG, Di Cori A, Segreti L, Zucchelli G, Viani S, Paperini L, Menichetti F, Coluccia G, Soldati E. Where is the future of cardiac lead extraction heading? Expert Rev Cardiovasc Ther 2016; 14:1197-203. [DOI: 10.1080/14779072.2016.1220832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Cardiac implantable electronic device infection due to Mycobacterium species: a case report and review of the literature. BMC Res Notes 2016; 9:414. [PMID: 27553460 PMCID: PMC4995631 DOI: 10.1186/s13104-016-2221-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/15/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Infection of cardiac implantable electronic devices is a serious cardiovascular disease and it is associated with a high mortality. Mycobacterium species may rarely cause cardiac implantable electronic devices infection. CASE PRESENTATION We are reporting a case of miliary tuberculosis in an Arab patient with dilated cardiomyopathy and a cardiac resynchronization therapy-defibrillator device that was complicated with infection of his cardiac resynchronization therapy-defibrillator device. To our knowledge, this is the third case in the literature with such a presentation and all patients died during the course of treatment. This underscores the importance of early diagnosis and management. We also performed a literature review of reported cases of cardiac implantable electronic devices infection related to Mycobacterium species. CONCLUSIONS Cardiac implantable electronic devices infection due to Mycobacterium species is an uncommon but a well-known entity. Early diagnosis and prompt management may result in a better outcome.
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Daptomycin for the treatment of major gram-positive infections after cardiac surgery. J Cardiothorac Surg 2016; 11:120. [PMID: 27488025 PMCID: PMC4972954 DOI: 10.1186/s13019-016-0519-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/27/2016] [Indexed: 01/25/2023] Open
Abstract
Background Infection is a main cause of morbidity and mortality after heart surgery, with multi-resistant pathogens increasingly representing a challenge. Daptomycin provides bactericidal activity against gram-positive organisms that are resistant to standard treatment including vancomycin. Methods A cohort of cardiac surgical patients, treated with daptomycin for major infection at two tertiary care centers, were retrospectively studied with a particular focus on the type of infection, causative pathogens and co-infections, daptomycin dosage, adverse events and outcome in order to provide evidence for the efficiency and safety of daptomycin in a distinct high-risk patient population. Results Sixty-five patients (87.7 % males, 60.4 ± 13.5 years) who had undergone aortic surgery (20.0 %), ventricular assist device (VAD) implantation (21.5 %), combined procedures (21.5 %), coronary artery bypass grafting (12.3 %), isolated valve surgery (15.4 %) and heart transplantation (7.7 %) were diagnosed with catheter-related infection (26.1 %), valve endocarditis (18.8 %), sternal wound (13.0 %), VAD-associated (11.6 %), cardiac implantable electrophysiological device (CIED)-associated (4.1 %), respiratory tract (4.3 %), bloodstream (4.3 %) and other infection (4.3 %). In 13.0 %, no focus of infection was identified though symptoms of severe infection were present. The most frequent pathogens were Staphylococcus epidermidis (30.4 %), Staphylococcus aureus (23.1 %) and Enterococcus species (10.1 %). Daptomycin doses ranging from 3 mg/kg every 48 h to 10 mg/kg every 24 h were administered for 15.4 ± 11.8 days. 87.0 % of the cases were classified as success, 7.2 % as treatment failure and 5.8 as non-evaluable. Adverse events were limited to one case of mild and one case of moderate neutropenia with recovery upon termination of treatment. Conclusion Daptomycin proved safe and effective in major infection in high-risk cardiac surgical patients.
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Korantzopoulos P, Sideris S, Dilaveris P, Gatzoulis K, Goudevenos JA. Infection control in implantation of cardiac implantable electronic devices: current evidence, controversial points, and unresolved issues. Europace 2016; 18:473-478. [DOI: 10.1093/europace/euv260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Chaudhry UA, Harling L, Ashrafian H, Athanasiou C, Tsipas P, Kokotsakis J, Athanasiou T. Surgical management of infected cardiac implantable electronic devices. Int J Cardiol 2016; 203:714-21. [DOI: 10.1016/j.ijcard.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Koruth JS, Rippy MK, Khairkhahan A, Ligon DA, Hubbard CA, Miller MA, Dukkipati S, Neuzil P, Reddy VY. Percutaneous Retrieval of Implanted Leadless Pacemakers. JACC Clin Electrophysiol 2015; 1:563-570. [DOI: 10.1016/j.jacep.2015.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/23/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3126] [Impact Index Per Article: 347.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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Rouzet F, Hyafil F, Le Guludec D. FDG PET/CT in cardiac electronic devices infection: Now is the time to target guidelines implementation. J Nucl Cardiol 2015; 22:800-3. [PMID: 25910755 DOI: 10.1007/s12350-015-0102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 01/03/2023]
Affiliation(s)
- François Rouzet
- Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, 46 rue Henri Huchard, 75018, Paris, France
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Ann HW, Ahn JY, Jeon YD, Jung IY, Jeong SJ, Joung B, Lee M, Ku NS, Han SH, Kim JM, Choi JY. Incidence of and risk factors for infectious complications in patients with cardiac device implantation. Int J Infect Dis 2015; 36:9-14. [PMID: 25980618 DOI: 10.1016/j.ijid.2015.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The use of cardiac implantable electronic device (CIED; pacemakers, implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) implantation, one essential treatment for cardiac arrhythmias, is increasing. Infectious complications related to implants are the main reason for device removal and patient morbidity. We sought to identify the incidence of infectious complications among patients with cardiac device implantation and analyze the risk factors for infectious complications. METHODS A retrospective analysis was conducted of 1307 patients (61.5±14.2 years-old, 49.6% male) with cardiac device implantation from January 1990 to April 2013. We analyzed the incidence of infectious complications during the follow-up period. To investigate risk factors associated with infectious complications, we conducted a 1:2 matched case-control study of patients with infectious complications and controls without infectious complications who had the same implantation period and physician. RESULTS Among 1307 patients, 12 had a confirmed device-related infection: 7 with a pocket infection and 5 with infective endocarditis. Over a total of 9091.9 device-years, the incidence of infectious complications was 1.3/1000 device-years, based on the 12 patients with an infection. ICD (5.1/1000 device-year) had a higher incidence of infectious complications than other cardiac devices, and no infectious complications were observed among patients with CRT implantation. Mean duration from the time of implantation to infection was 2.02±1.65 years. In a multivariate analysis, the number of prior procedures including wound revision or scar revision was an independent risk factor for infectious complications (OR=10.88, 95% CI 1.11->999, p=0.040). CONCLUSIONS Infection was a rare complication of cardiac device implantation, but repeated procedures were associated with infectious complications.
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Affiliation(s)
- Hea Won Ann
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Yong Duk Jeon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - MoonHyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; AIDS Research Institute.
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Zhang S, Kriza C, Schaller S, Kolominsky-Rabas PL. Recalls of cardiac implants in the last decade: what lessons can we learn? PLoS One 2015; 10:e0125987. [PMID: 25962074 PMCID: PMC4427435 DOI: 10.1371/journal.pone.0125987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/27/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Due to an ageing population and demographic changes worldwide, a higher prevalence of heart disease is forecasted, which causes an even higher demand for cardiac implants in future. The increasing high incidence of clinical adverse events attributed especially to high-risk medical devices has led an advocated change from many stakeholders. This holds especially true for devices like cardiac implants, with their high-risk nature and high complication rates associated with considerable mortality, due to their frequent use in older populations with frequent co-morbidities. To ensure patients' safety, the objective of this study is to analyze different cardiac implants recall reasons and different recall systems, based on an overview of the recalls of cardiac implant medical devices in the last decade. On the basis of the results from this structured analysis, this study provides recommendations on how to avoid such recalls from a manufacturer perspective, as well as how to timely react to an adverse event from a post-surveillance system perspective. METHODS AND FINDINGS A systematic search of cardiac implant recalls information has been performed in the PubMed, ScienceDirect and Scopus databases, as well as data sources in regulatory authorities from 193 UN Member States. Data has been extracted for the years 2004-2014 with the following criteria applied: cardiac implant medical device recalls and reasons for recall, associated harm or risk to patients. From the data sources described above, eleven regulatory authorities and 103 recall reports have been included in this study. The largest cardiac implant categories include ICDs 40.8%, pacemakers 14.5% and stents 14.5%. Regarding the recall reasons, the majority of reports were related to device battery problems (33.0%) and incorrect therapy delivery (31.1%). From a total of 103 recall reports, five reported death and serious injuries. Our review highlights weaknesses in the current cardiac implant recall system, including data reporting and management issues and provides recommendations for the improvement of safety information and management. CONCLUSION Due to the mortality associated with the nature of cardiac implants, the traceability and transparency of safety hazards information is crucial. By a structured analysis of recall reasons and their efficient management, important knowledge is gained to inform an effective safety-reporting system for monitoring the safety of cardiac implanted patients, ideally by building up cardiac implant registries worldwide in the future.
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Affiliation(s)
- Shixuan Zhang
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), University of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Christine Kriza
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), University of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- National Leading-Edge Cluster Medical Technologies “Medical Valley EMN”, Erlangen, Bavaria, Germany
| | - Sandra Schaller
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), University of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Peter L. Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), University of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- National Leading-Edge Cluster Medical Technologies “Medical Valley EMN”, Erlangen, Bavaria, Germany
- * E-mail:
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Gurunathan S, Senior R. Right ventricular lead perforation complicating late pacemaker infection. Int J Cardiol 2015; 190:47-8. [PMID: 25912119 DOI: 10.1016/j.ijcard.2015.04.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
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Abstract
Implantable cardioverter-defibrillators (ICD) have become an integral component in the management of children with life-threatening cardiac arrhythmias complicating a variety of different inherited and congenital cardiovascular conditions. Implantation often requires novel approaches and configurations to overcome the size and anatomic limitations posed by many children needing ICDs. While their use has undoubtedly saved many lives, ICD use may be associated with significant morbidity, so detailed case selection and individualised postimplant programming is critical.
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Affiliation(s)
- Elizabeth S DeWitt
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dominic J Abrams
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Boston, Massachusetts, USA
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KORUTH JACOBS, RIPPY MARIANK, KHAIRKHAHAN ALEXANDER, LIGON DAVIDA, HUBBARD CHRISTOPHERA, GOAR FREDERICKST, LEE RANDALL, RIBEIRO LEONARDO, MILLER MARC, DUKKIPATI SRINIVAS, NEUZIL PETR, REDDY VIVEKY. Feasibility and Efficacy of Percutaneously Delivered Leadless Cardiac Pacing in an In Vivo
Ovine Model. J Cardiovasc Electrophysiol 2014; 26:322-8. [DOI: 10.1111/jce.12579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/06/2014] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- JACOB S. KORUTH
- Helmsley Electrophysiology Center; Mount Sinai Medical Center; New York New York USA
| | | | | | | | | | | | - RANDALL LEE
- University of California; San Francisco; School of Medicine; San Francisco; California USA
| | - LEONARDO RIBEIRO
- Helmsley Electrophysiology Center; Mount Sinai Medical Center; New York New York USA
| | - MARC MILLER
- Helmsley Electrophysiology Center; Mount Sinai Medical Center; New York New York USA
| | - SRINIVAS DUKKIPATI
- Helmsley Electrophysiology Center; Mount Sinai Medical Center; New York New York USA
| | | | - VIVEK Y. REDDY
- Helmsley Electrophysiology Center; Mount Sinai Medical Center; New York New York USA
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37
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Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I, Sarriá C, Olmos C, Ferrera C, García PE, Sáez C, Gómez I, San Román JA. Clinical classification and prognosis of isolated right-sided infective endocarditis. Medicine (Baltimore) 2014; 93:e137. [PMID: 25501052 PMCID: PMC4602814 DOI: 10.1097/md.0000000000000137] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the "3 noes" endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted.Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 "3 noes" group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The "3 noes" endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the "3 noes" group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the "3 noes", P < 0.001). Significant differences in mortality were found (17% in drug users, 3% in device carriers, and 30% in the "3 noes" group; P < 0.001). These results suggest that RSIE should be separated into 3 groups (IDUs, cardiac device carriers, and the "3 noes") and considered as independent entities as there are relevant epidemiologic, clinical, microbiological, echocardiographic, and prognostic differences among them.
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Affiliation(s)
- Carlos Ortiz
- From the Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid (CO, JL, HG, TS, AR, PEG, IG, JASR); Hospital Clínico Universitario San Carlos (IV, CO, CF); and Servicio de Medicina Interna-Infecciosas, Instituto de Investigación del Hospital La Princesa, Madrid, Spain (CS, CS)
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Deckx S, Marynissen T, Rega F, Ector J, Nuyens D, Heidbuchel H, Willems R. Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience. Europace 2014; 16:1218-25. [DOI: 10.1093/europace/eut410] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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39
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Cardiac device infections is associated with pocket hematoma and diabetes mellitus: the role of the cardiovascular nurse. Int J Cardiol 2014; 171:e5-7. [PMID: 24309082 DOI: 10.1016/j.ijcard.2013.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/19/2013] [Accepted: 11/18/2013] [Indexed: 11/23/2022]
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40
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Ejima K, Shoda M, Yashiro B, Yoshida K, Nuki T, Kato K, Manaka T, Hagiwara N. Unusual "ratchet syndrome": spontaneous lead retraction after a generator exchange. Heart Vessels 2013; 29:550-3. [PMID: 23846318 DOI: 10.1007/s00380-013-0392-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
A 72-year-old female with idiopathic dilated cardiomyopathy underwent a generator exchange for a cardiac resynchronization therapy defibrillator with a full-pocket capsulectomy. The lead position after the operation was identical to that before the operation on the chest X-ray. After 4 months, a subacute exacerbation of her heart failure was caused by cardiac resynchronization therapy failure due to a dislodgement of the left ventricular lead. An aggressive adhesiotomy of the connective tissue around the leads made it possible for the lead to retract by a ratchet-like movement through the suture sleeve, so-called "ratchet syndrome", after the generator exchange.
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Affiliation(s)
- Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan,
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