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Matteucci A, Pignalberi C, Pandozi C, Magris B, Meo A, Russo M, Galeazzi M, Schiaffini G, Aquilani S, Di Fusco SA, Colivicchi F. Prevention and Risk Assessment of Cardiac Device Infections in Clinical Practice. J Clin Med 2024; 13:2707. [PMID: 38731236 PMCID: PMC11084741 DOI: 10.3390/jcm13092707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/28/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
The implantation of cardiac electronic devices (CIEDs), including pacemakers and defibrillators, has become increasingly prevalent in recent years and has been accompanied by a significant rise in cardiac device infections (CDIs), which pose a substantial clinical and economic burden. CDIs are associated with hospitalizations and prolonged antibiotic therapy and often necessitate device removal, leading to increased morbidity, mortality, and healthcare costs worldwide. Approximately 1-2% of CIED implants are associated with infections, making this a critical issue to address. In this contemporary review, we discuss the burden of CDIs with their risk factors, healthcare costs, prevention strategies, and clinical management.
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Affiliation(s)
- Andrea Matteucci
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
- Department of Experimental Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Carlo Pignalberi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Claudio Pandozi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Barbara Magris
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Antonella Meo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Maurizio Russo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Marco Galeazzi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giammarco Schiaffini
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
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Ziacchi M, Biffi M, Iacopino S, di Silvestro M, Marchese P, Miscio F, Caccavo VP, Zanotto G, Tomasi L, Dello Russo A, Donazzan L, Boriani G. REducing INFectiOns thRough Cardiac device Envelope: insight from real world data. The REINFORCE project. Europace 2023; 25:euad224. [PMID: 37490930 PMCID: PMC10637307 DOI: 10.1093/europace/euad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/18/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS Infections resulting from cardiac implantable electronic device (CIED) implantation are severely impacting on patients' and on health care systems. The use of TYRXTM absorbable antibiotic-eluting envelope has proven to decrease major CIED infections within 12 months of CIED surgery. The aim is to evaluate the impact of the envelope use on infection-related clinical events in a real-world contemporary patient population. METHODS AND RESULTS Data on patients undergoing CIED surgery were collected prospectively by participating centers of the One Hospital ClinicalService project. Patients were divided into two groups according to whether TYRXTM absorbable antibiotic-eluting envelope was used or not. Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and included in the Envelope group and 947 (52.1%) patients who did not receive an envelope were included in the Control group. Compared to control, patients in the Envelope group had higher thrombo-embolic or hemorrhagic risk, higher BMI, lower LVEF and more comorbidities. During a mean follow-up of 1.4 years, the incidence of infection-related events was significantly higher in the control compared to the Envelope group (2.4% vs. 0.8%, P = 0.007). The five-year cumulative incidence of infection-related events was 8.1% in the control and 2.1% in the Envelope group (HR: 0.34, 95%CI: 0.14-0.80, P = 0.010). CONCLUSION In our analysis, the use of an absorbable antibiotic-eluting envelope in the general CIED population was associated with a lower risk of systemic and pocket infection.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40125 Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, 40125 Bologna, Italy
| | | | | | | | | | | | | | | | | | - Luca Donazzan
- Cardiology Department, Ospedale San Maurizio, Bolzano, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Toriello F, Saviano M, Faggiano A, Gentile D, Provenzale G, Pollina AV, Gherbesi E, Barbieri L, Carugo S. Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature. J Clin Med 2022; 11:5898. [PMID: 36233765 PMCID: PMC9570622 DOI: 10.3390/jcm11195898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022] Open
Abstract
The use of increasingly complex cardiac implantable electronic devices (CIEDs) has increased exponentially in recent years. One of the most serious complications in terms of mortality, morbidity and financial burden is represented by infections involving these devices. They may affect only the generator pocket or be generalised with lead-related endocarditis. Modifiable and non-modifiable risk factors have been identified and they can be associated with patient or procedure characteristics or with the type of CIED. Pocket and systemic infections require a precise evaluation and a specialised treatment which in most cases involves the removal of all the components of the device and a personalised antimicrobial therapy. CIED retention is usually limited to cases where infection is unlikely or is limited to the skin incision site. Optimal re-implantation timing depends on the type of infection and on the results of microbiological tests. Preventive strategies, in the end, include antibiotic prophylaxis before CIED implantation, the possibility to use antibacterial envelopes and the prevention of hematomas. The aim of this review is to investigate the pathogenesis, stratification, diagnostic tools and management of CIED infections.
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Affiliation(s)
- Filippo Toriello
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Saviano
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Domitilla Gentile
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanni Provenzale
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alberto Vincenzo Pollina
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Gherbesi
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lucia Barbieri
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Sfairopoulos D, Konstantinou CS, Korantzopoulos P. A false alarm: Pacemaker pocket pseudo-infection. J Arrhythm 2022; 38:486-487. [PMID: 35785382 PMCID: PMC9237290 DOI: 10.1002/joa3.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
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Ngiam JN, Liong TS, Sim MY, Chew NWS, Sia CH, Chan SP, Lim TW, Yeo TC, Tambyah PA, Loh PH, Poh KK, Kong WKF. Risk Factors for Mortality in Cardiac Implantable Electronic Device (CIED) Infections: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11113063. [PMID: 35683451 PMCID: PMC9181812 DOI: 10.3390/jcm11113063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Infections following cardiac implantable electronic device (CIED) implantation can require surgical device removal and often results in significant cost, morbidity, and potentially mortality. We aimed to systemically review the literature and identify risk factors associated with mortality following CIED infection. Methods: Electronic searches (up to June 2021) were performed on PubMed and Scopus. Twelve studies (10 retrospective, 2 prospective cohort studies) were included for analysis. Meta-analysis was conducted with the restricted maximum likelihood method, with mortality as the outcome. The overall mortality was 13.7% (438/1398) following CIED infection. Results: On meta-analysis, the male sex (OR 0.77, 95%CI 0.57–1.01, I2 = 2.2%) appeared to have lower odds for mortality, while diabetes mellitus appeared to be associated with higher mortality (OR 1.47, 95%CI 0.67–3.26, I2 = 81.4%), although these trends did not reach statistical significance. Staphylococcus aureus as the causative organism (OR 2.71, 95%CI 1.76–4.19, I2 = 0.0%), presence of heart failure (OR 1.92, 95%CI 1.42–4.19, I2 = 0.0%) and embolic phenomena (OR 4.00, 95%CI 1.67–9.56, I2 = 69.8%) were associated with higher mortality. Surgical removal of CIED was associated with lower mortality compared with conservative management with antibiotics alone (OR 0.22, 95%CI 0.09–0.50, I2 = 62.8%). Conclusion: We identified important risk factors associated with mortality in CIED infections, including Staphyloccocus aureus as the causative organism, and the presence of complications, such as heart failure and embolic phenomena. Surgery, where possible, was associated with better outcomes.
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Affiliation(s)
- Jinghao Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
| | - Tze Sian Liong
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Meng Ying Sim
- Department of Medicine, National University Health System, Singapore 119228, Singapore; (T.S.L.); (M.Y.S.)
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Cardiovascular Research Institute, National University Health System, Singapore 119074, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore; (J.N.N.); (P.A.T.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore 119074, Singapore; (N.W.S.C.); (C.-H.S.); (T.W.L.); (T.-C.Y.); (P.H.L.); (K.K.P.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Correspondence: ; Tel.: +65-67722476; Fax: +65-68722998
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Longtin Y, Gervais P, Birnie DH, Wang J, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Krahn AD. Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT). Open Forum Infect Dis 2021; 8:ofab513. [PMID: 34859113 PMCID: PMC8632784 DOI: 10.1093/ofid/ofab513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. Methods This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. Trial registration NCT01002911.
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Affiliation(s)
- Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Philippe Gervais
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marco Alings
- Amphia Ziekenhuis & Working Group on Cardiovascular Research (WCN), Breda, the Netherlands
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Eugene Crystal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Leon Rioux
- Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Ziekenhuis Rijnstate, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
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Kohli U, Hazra A, Shahab A, Beaser AD, Aziz ZA, Upadhyay GA, Ozcan C, Tung R, Nayak HM. Atypical pathogens associated with cardiac implantable electronic device infections. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1549-1561. [PMID: 34245025 PMCID: PMC9290787 DOI: 10.1111/pace.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens. METHODS Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection-related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated. RESULTS Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection-related deaths. CONCLUSIONS CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.
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Affiliation(s)
- Utkarsh Kohli
- Section of Pediatric Cardiology, Department of Pediatrics, Comer Children's Hospital and the University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Cardiology/Electrophysiology, Department of Pediatrics, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases & Global Health, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ahmed Shahab
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Andrew D Beaser
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Zaid A Aziz
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Cevher Ozcan
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Roderick Tung
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Hemal M Nayak
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Abstract
Background The CanGaroo® Envelope (Aziyo Biologics, Silver Spring, MD) is intended to securely hold a cardiovascular implantable electronic device (CIED) to create a stable environment when implanted in the body. Data on the utilization of this newly available product are limited. Objective In this study, our objective was to describe the specific profiles of patients who may benefit from the use of the CanGaroo® Envelope at the time of CIED implantation. Methods The utilization of the CanGaroo® Envelope was assessed from January 2019 to October 2019 among a series of patients who were either undergoing de-novo CIED implantation or replacement. Results Among a total of 50 patients, the CanGaroo® Envelope was utilized in 15 (30%). Three distinct patient profiles were identified: profile 1: elderly patients with poor tissue turgor at risk of wound dehiscence or erosion; profile 2: patients with a history of previous device infection; and profile 3: patients at high risk of device infection having one or more of the following risk factors - chronic kidney disease, immunocompromised state, or diabetes mellitus. At a mean follow-up of 18 ±3 months, no CIED pocket erosion, dehiscence, or infection was noted. Conclusions Three distinct profiles of patients who could potentially benefit from the use of the CanGaroo® Envelope were identified by the implanting physicians. Long-term follow-up data, including infection and wound dehiscence rates, are necessary to further analyze the optimal utilization of the device.
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Affiliation(s)
- Hemal Nayak
- Cardiac Electrophysiology, University of Chicago Medicine, Chicago, USA
| | - Andrew D Beaser
- Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, USA
| | - Zaid A Aziz
- Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, USA
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Archontakis S, Pirounaki M, Aznaouridis K, Karageorgopoulos D, Sideris K, Tolios P, Triantafyllou K, Gatzoulis K, Tousoulis D, Sideris S. Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications. J Cardiovasc Electrophysiol 2020; 32:491-499. [PMID: 33345428 DOI: 10.1111/jce.14841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection. METHODS AND RESULTS Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001). CONCLUSIONS Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.
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Affiliation(s)
| | - Maria Pirounaki
- Second Department of Medicine, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | | | | | - Panagiotis Tolios
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | | | - Konstantinos Gatzoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
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10
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Ishiguchi H, Ishikura M, Yoshida M, Imoto K, Sonoyama K, Kawabata T, Ishihara Y, Yoshiga Y, Shimizu A, Oda T. Incidence and risk factors for cardiac implantable electronic device infection in current clinical settings in a Japanese population: A 20-year single-center observational study. J Cardiol 2020; 76:115-122. [DOI: 10.1016/j.jjcc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/12/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
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11
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Raza SA, Opie NL, Morokoff A, Sharma RP, Mitchell PJ, Oxley TJ. Endovascular Neuromodulation: Safety Profile and Future Directions. Front Neurol 2020; 11:351. [PMID: 32390937 PMCID: PMC7193719 DOI: 10.3389/fneur.2020.00351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the StentrodeTM, a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the StentrodeTM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the StentrodeTM, the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the StentrodeTM and define avenues where further research and development are necessary in order to optimize this device for human application.
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Affiliation(s)
- Samad A Raza
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nicholas L Opie
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rahul P Sharma
- Interventional Cardiology, Stanford Health Care, Palo Alto, CA, United States
| | - Peter J Mitchell
- Department of Radiology, The University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas J Oxley
- Department of Medicine, Vascular Bionics Laboratory, Melbourne Brain Centre, The University of Melbourne, Melbourne, VIC, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
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12
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Kabulski GM, Northup A, Wiggins BS. Postoperative Antibiotic Prophylaxis Following Cardiac Implantable Electronic Device Placement. J Innov Card Rhythm Manag 2019; 10:3777-3784. [PMID: 32477744 PMCID: PMC7252755 DOI: 10.19102/icrm.2019.100804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/19/2019] [Indexed: 02/01/2023] Open
Abstract
Infections related to cardiac implantable electronic device (CIED) placement are associated with poor clinical outcomes. As such, preprocedural prophylactic antibiotic therapy is indicated for all patients prior to device insertion. However, the available data are less clear on the impact of postprocedural antibiotic therapy on rates of CIED infection when used in addition to preprocedural therapy. This is single-center, retrospective cohort study of 913 patients who underwent CIED-related procedures between October 2010 and August 2014 sought to compare the rate of CIED infections in patients receiving only preprocedural antibiotics with those receiving both preprocedural and postprocedural antibiotics. Univariate analysis was used to detect independent risk factors for CIED infection. After excluding patients receiving concomitant antibiotics for other conditions, those undergoing CIED extraction alone, and those with a lack of follow-up data and/or adequate documentation of clinical encounters, 569 patients were identified for inclusion in the final analysis. The majority of patients who received postprocedural antibiotics received three to five days of therapy, with the most common antibiotic used being cephalexin. There was no statistically significant difference in the incidence of infection between patients who did and did not receive postoperative antibiotics (4.5% versus 6.1%; p = 0.398). In a multivariate analysis, the use of postprocedural antibiotic therapy was not a significant risk factor for infection (adjusted odds ratio: 0.692; 95% confidence interval: 0.314–1.525; p = 0.361). It is therefore reasonable to withhold prescribing postoperative antibiotics in patients following CIED implantation. Individualized risk factor evaluation of patient comorbidities and procedural characteristics may be needed to aid in determining whether postoperative antibiotics are reasonable in different patients. The validity of these findings is contingent on further confirmation via a prospective, randomized clinical trial.
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Affiliation(s)
- Galen M Kabulski
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.,College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Northup
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Barbara S Wiggins
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.,College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
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13
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LeBlanc NL, Agarwal D, Menzen E, Nomi K, Sisson DD, Scollan KF. Prevalence of major complications and procedural mortality in 336 dogs undergoing interventional cardiology procedures in a single academic center. J Vet Cardiol 2019; 23:45-57. [PMID: 31174729 DOI: 10.1016/j.jvc.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Overall complication rates associated with a wide range of diagnostic and therapeutic interventional cardiac procedures in a contemporary academic setting have not been reported. ANIMALS, MATERIALS AND METHODS Consecutive interventional procedures performed for client-owned dogs were retrospectively analyzed to characterize procedural complications and mortality. RESULTS Three hundred sixty-four procedures were performed on 336 dogs. Interventions included attempted or completed transvenous pacemaker (PM) implantation (n = 134) with subsequent pacing system revision (n = 8), pulmonic balloon valvuloplasty (BVP) (n = 117) with a subset of patients undergoing an additional BVP (n = 14), transarterial closure of left-to-right shunting patent ductus arteriosus (PDA) (n = 66), diagnostic angiography and/or cardiovascular pressure measurement (n = 9), transvenous temporary pacing (n = 7), septal defect occlusion (n = 5), heartworm extraction (n = 3), and BVP catheter fragment retrieval (n = 1). The prevalence of major perioperative and postoperative complications for all procedures was 5% and 6%, respectively, and the procedural mortality rate was 2%. The overall rate of major complications was 12% for the PM group, 11% for the BVP group, and 2% for the PDA occlusion group. Both PM implantation and BVP have higher rates of major complications overall compared with PDA occlusion (p=0.0151). CONCLUSIONS The results of this study indicate that the prevalence of major complications and mortality associated with interventional cardiac procedures is low; however, significant differences exist in complication rates between procedures.
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Affiliation(s)
- N L LeBlanc
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA.
| | - D Agarwal
- MedVet Medical and Cancer Center for Pets, Cardiology Department, 3964 Red Bank Road, Cincinnati, Ohio 45227, USA
| | - E Menzen
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K Nomi
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - D D Sisson
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K F Scollan
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
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14
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Perrin T, Maille B, Lemoine C, Resseguier N, Franceschi F, Koutbi L, Hourdain J, Deharo JC. Comparison of epicardial vs. endocardial reimplantation in pacemaker-dependent patients with device infection. Europace 2019; 20:e42-e50. [PMID: 28582500 DOI: 10.1093/europace/eux111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/30/2017] [Indexed: 12/29/2022] Open
Abstract
Aims Reimplantation of cardiac implantable electronic devices (CIEDs) after extraction due to device infection is a major issue in pacemaker-dependent patients. We compared in-hospital and long-term outcomes with two techniques: epicardial reimplantation (EPI) before CIED extraction and temporary pacing (TP) with a view to delayed endocardial reimplantation. Methods and results Two cohorts of consecutive pacemaker-dependent patients who underwent transvenous lead extraction at our tertiary centre were included in this retrospective cohort study. According to successive policies, either the EPI or the TP approach was used. In-hospital complications occurred at similar rates in the EPI (n = 59) and TP (n = 52) cohorts (37.3% vs. 32.7%, respectively; P = 0.61). Thirteen (25.0%) patients in the TP cohort eventually were reimplanted epicardially, mainly because of infection of the temporary lead. Finally, 65 patients were discharged with an epicardial device and 37 with an endocardial device. Median follow-up was 41.7 (interquartile range 34.1-51.5) months. No difference was observed in long-term mortality according to the reimplantation strategy, but use of TP was associated with a reduced risk of late endocarditis and device reintervention (hazard ratio (HR) 0.25, 95% confidence interval (CI) 0.09-0.069, P = 0.01), whereas epicardial device reimplantation was associated with an increased risk (HR 3.62, 95% CI 1.07-12.21, P = 0.04). Conclusion We observed similar in-hospital outcomes in our EPI and TP cohorts. Twenty-five percent of the patients initially paced by a TP strategy finally needed an epicardial device, mainly because of infection of their TP lead. Use of TP resulted in lower rates of late endocarditis and device reintervention.
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Affiliation(s)
- Tilman Perrin
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Baptiste Maille
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Coralie Lemoine
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Noémie Resseguier
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Frédéric Franceschi
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Linda Koutbi
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Jérôme Hourdain
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
| | - Jean-Claude Deharo
- Service de Cardiologie-Rythmologie, CHU Timone, 264 Rue Saint-Pierre, 13385 Marseille, France
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15
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Zhang W, Hu J, Zhou Y, Chen Y, Yu F, Hong C, Chen L, Xin H, Hong K, Wang X. Latex and a ZnO-based multi-functional material for cardiac implant-related inflammation. Biomater Sci 2019; 7:4186-4194. [DOI: 10.1039/c9bm00952c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A new memory latex foam with ZnO modification was developed to reduce the incidence of both bacteria- and shaking-induced pocket inflammation.
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Affiliation(s)
- Wei Zhang
- College of Chemistry
- Nanchang University
- Nanchang
- P.R. China
| | - Jinzhu Hu
- Department of Cardiovascular Medicine
- The Second Affiliated Hospital of Nanchang University
- Nanchang
- P.R. China
| | - Yan Zhou
- The National Engineering Research center for Bioengineering Drugs and the Technologies
- Institute of Translational Medicine
- Nanchang University
- Nanchang
- P.R. China
| | - Yutong Chen
- The National Engineering Research center for Bioengineering Drugs and the Technologies
- Institute of Translational Medicine
- Nanchang University
- Nanchang
- P.R. China
| | - Fen Yu
- College of Chemistry
- Nanchang University
- Nanchang
- P.R. China
| | - Can Hong
- The National Engineering Research center for Bioengineering Drugs and the Technologies
- Institute of Translational Medicine
- Nanchang University
- Nanchang
- P.R. China
| | - Liming Chen
- College of Chemistry
- Nanchang University
- Nanchang
- P.R. China
| | - Hongbo Xin
- The National Engineering Research center for Bioengineering Drugs and the Technologies
- Institute of Translational Medicine
- Nanchang University
- Nanchang
- P.R. China
| | - Kui Hong
- Department of Cardiovascular Medicine
- The Second Affiliated Hospital of Nanchang University
- Nanchang
- P.R. China
| | - Xiaolei Wang
- College of Chemistry
- Nanchang University
- Nanchang
- P.R. China
- The National Engineering Research center for Bioengineering Drugs and the Technologies
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16
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Özcan C, Raunsø J, Lamberts M, Køber L, Lindhardt TB, Bruun NE, Laursen ML, Torp-Pedersen C, Gislason GH, Hansen ML. Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study. Europace 2018; 19:1007-1014. [PMID: 28073883 DOI: 10.1093/europace/euw404] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
Aims To determine the incidence, risk factors, and mortality of infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED). Methods and results From Danish nationwide administrative registers (beginning in 1996), we identified all de-novo permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) together with the occurrence of post-implantation IE-events in the period from 2000-2012. Included were 43 048 first-time PM/ICD recipients. Total follow-up time was 168 343 person-years (PYs). The incidence rate (per 1000 PYs) of IE in PM was 2.1 (95% confidence interval [CI]: 1.7-2.6) for single chamber devices and 6.2 (95% CI: 4.5-8.7) for cardiac resynchronization therapy (CRT); similarly, the rate of IE in ICD was 3.7 (95% CI: 2.9-4.7) in single chamber devices and 6.3 (95% CI: 4.4-9.0) in CRT. In multivariable analysis, increased PM complexity served as independent risk factor for IE {dual chamber PM [hazard ratio (HR) 1.39; 95% CI: 1.07-1.80] and CRT [HR: 1.84; 95% CI: 1.20-2.84]}. During follow-up, generator replacement (HR: 2.79; 95% CI: 1.87-4.17) and lead revision (HR: 4.33; 95% CI: 3.25-5.78) in PMs were associated with increased risk. Corresponding estimates in ICDs were 2.49 (95% CI: 1.28-4.86) and 6.58 (95% CI: 4.49-9.63). Risk of death after IE was significantly increased in PM and ICD with HRs of 1.56 (95% CI: 1.33-1.82) and 2.63 (95% CI: 2.00-3.48), respectively. Conclusion The risk of IE increased with increasing PM complexity. Other important risk factors were subsequent generator replacement and lead revision. IE was associated with an increased risk of mortality in the area of CIED.
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Affiliation(s)
- Cengiz Özcan
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.,Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen Ø, Denmark
| | - Tommi Bo Lindhardt
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.,Clinical Institute, Aalborg University, 9000 Aalborg, Denmark
| | | | | | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark
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17
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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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18
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Sousa ÁFLD, Marques DM, Monteiro RM, Queiroz AAFL, Andrade D, Watanabe E. Prevenção da formação de biofilmes em marcapassos artificiais: é viável? ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Identificar os agentes antimicrobianos utilizados na prevenção da formação de biofilme em marcapassos artificiais. Métodos: Revisão da literatura para responder a seguinte questão: “Quais agentes antimicrobianos são usados para prevenir a formação de biofilmes em marcapassos artificiais?” As bases de dados PubMed, Web of Science, Scopus, Science Direct, Cochrane, CINAHL, Embase e LILACS foram consultadas em todos os idiomas sem restrição de tempo. Resultados: A amostra final apresentou cinco estudos primários, sendo a maioria experimental. As investigações identificaram agentes com potencial para a redução ou inibição da formação de biofilmes em marcapassos. Destacou-se a associação de agentes físico-químicos e farmacológicos aos agentes antimicrobianos. Conclusão: A prevenção da formação de biofilmes em marcapassos é viável. Os agentes mais promissores para obter este efeito foram a rifampicina, AIGIS®, a formulação aquosa neobactrim e a cobertura com trimetilsilano e oxigênio em superfícies tratadas com plasma.
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19
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Arrhythmic risk stratification in non-ischemic dilated cardiomyopathy: Where do we stand after DANISH? Trends Cardiovasc Med 2017; 27:542-555. [DOI: 10.1016/j.tcm.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/21/2017] [Accepted: 06/02/2017] [Indexed: 12/13/2022]
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Abstract
Cardiac implantable electronic device (CIED) infections are complex medical problems that are increasingly encountered. They are associated with significant morbidity and mortality with tremendous economic cost. The current review will emphasize the prevention, diagnosis, and treatment of this clinical entity using the relatively limited evidence that is currently available. Because there is a paucity of high quality evidence regarding prevention, diagnosis, and treatment of CIED infections, this review will attempt to summarize the best evidence as well as to suggest, when possible, paradigms for care. The topic of CIED infections is a dynamic one as the scope of CIED continues to widen. Furthermore, there are promising advancements in CIED technology which may help reduce its occurrence the future. Unfortunately, significant gaps in knowledge remain, and definitive recommendations regarding CIED infections and future studies should be directed at improving our ability to prevent infections.
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Affiliation(s)
- Steven Leung
- Department of Medicine, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA
| | - Stephan Danik
- Department of Cardiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
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21
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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Carrasco F, Anguita M, Ruiz M, Castillo JC, Delgado M, Mesa D, Romo E, Pan M, Suárez de Lezo J. Clinical features and changes in epidemiology of infective endocarditis on pacemaker devices over a 27-year period (1987–2013). Europace 2015; 18:836-41. [DOI: 10.1093/europace/euv377] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
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