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Bertolino L, Florio LL, Patauner F, Gallo R, Peluso AM, Scafuri A, De Vivo S, Corrado C, Zampino R, Ruocco G, D’Onofrio A, Durante-Mangoni E. Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review. J Clin Med 2023; 12:7573. [PMID: 38137641 PMCID: PMC10743511 DOI: 10.3390/jcm12247573] [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: 11/11/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Leadless pacemakers (LPs) have been proposed as a reimplantation strategy in pacing-dependent patients undergoing cardiac implantable electronic device (CIED) extraction for infection. In this study, we analysed the risk of LP infection when this device is implanted before lead extraction. (2) Methods: This was a retrospective study including patients who underwent LP implantation between 2017 and 2022. Patients were divided in two groups according to whether LP was implanted following CIED extraction for infection (Group 1) or other indications (Group 2). The primary aim was to describe the risk of LP infection. (3) Results: We included in this study 49 patients with a median age of 81 [20-94] years, mostly males (36, 73%). In Group 1 patients, 17 cases (85%) showed systemic CIED infections, and 11 (55%) had positive lead cultures. Most Group 1 cases (n = 14, 70%) underwent one stage of LP implantation and CIED extraction. Mortality rate during follow-up was 20% (nine patients). Patients were followed up for a median of 927 [41-1925], days and no cases of definite or suspected LP infections were identified. (4) Conclusions: The risk of LP infection was extremely low. LP appears as a potential option for reimplantation in this setting and should be considered in pacing-dependent patients at a high risk of CIED infection recurrence.
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Affiliation(s)
- Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Letizia Lucia Florio
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Anna Maria Peluso
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Antonio Scafuri
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Stefano De Vivo
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Carmelina Corrado
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy;
| | - Antonio D’Onofrio
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
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Holcman K, Rubiś P, Ząbek A, Boczar K, Podolec P, Kostkiewicz M. Advances in Molecular Imaging in Infective Endocarditis. Vaccines (Basel) 2023; 11:vaccines11020420. [PMID: 36851297 PMCID: PMC9967666 DOI: 10.3390/vaccines11020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications. Developing molecular imaging modalities may provide additional insights into ongoing infection and support an accurate diagnosis. We present the current evidence for the diagnostic performance and indications for utilization in current guidelines of the hybrid modalities: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime-labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) along with positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). The role of molecular imaging in IE diagnostic work-up has been constantly growing due to technical improvements and the increasing evidence supporting its added diagnostic and prognostic value. The various underlying molecular processes of 99mTc-HMPAO-SPECT/CT as well as 18F-FDG PET/CT translate to different imaging properties, which should be considered in clinical practice. Both techniques provide additional diagnostic value in the assessment of patients at risk of IE. Nuclear imaging should be considered in the IE diagnostic algorithm, not only for the insights gained into ongoing infection at a molecular level, but also for the determination of the optimal clinical therapeutic strategies.
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Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
- Correspondence:
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
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