Clinical Presentation and Outcomes of Cardiovascular Implantable Electronic Device Infections in Hemodialysis Patients

Hickson, La Tonya J.; Gooden, Janelle Y.; Le, Katherine Y.; Baddour, Larry M.; Friedman, Paul A.; Hayes, David L.; Wilson, Walter R.; Steckelberg, James M.; Sohail, M. Rizwan

doi:10.1053/j.ajkd.2013.11.018

Cited by 36 publications

(26 citation statements)

References 21 publications

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“…Despite strict aseptic precautions at implantation, two patients developed infection requiring explant (two weeks and three months post implant respectively); this reflects the general susceptibility of dialysis patients to procedure related infections. [ 27 ] The Reveal XT is particularly sensitive for the detection of AF. Yet AF was incorrectly identified in many transmissions due to T wave over sensing resulting from intermittent deep T wave inversion, under sensing of R waves following a drop in the size of recorded QRS complexes, as well as noise/interference.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Roberts¹,

Zachariah

Morgan³

et al. 2017

PLoS ONE

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IntroductionIt has been suggested that sudden cardiac death (SCD) contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR) is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.Methods30 patients (60% male) aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23%) and left ventricular ejection fraction (LVEF) 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA) between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling) device and secondary outcome, the development of arrhythmia necessitating medical intervention.ResultsDuring 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient), there were 8 deaths—2 SCD and 6 due to generalised deterioration/sepsis. 5 (20%) patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia). 10 (33%) patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6–3.6 years).ConclusionsThe findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.

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Section: Discussionmentioning

confidence: 99%

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Roberts¹,

Zachariah

Morgan³

et al. 2017

PLoS ONE

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“…The previous factors highlight why diagnosis is difficult and often subject to delay. Time from symptom onset to diagnosis for all identified cases of Propionibacterium CIED‐related IE (mean, 74 days [±83]) was twice longer than what is previously described for CIED‐IE (mean, 36 days [±117]) . Delay in diagnosis may lead to undesirable complications.…”

Section: Discussionmentioning

confidence: 97%

Cardiovascular Implantable Electronic Device Infections due toPropionibacteriumSpecies

Rafei

DeSimone

Sohail

et al. 2016

Pacing and Clinical Electrophysiology

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Introduction Propionibacterium species are part of the normal skin flora and often considered contaminants when identified in cultures. However, they can cause life-threatening infections, including prosthetic cardiovascular device infections. Clinical presentation and management of cardiovascular implantable electronic device (CIED) infection due to Propionibacterium species has not been well described. Methods Retrospective review of all cases of CIED infection due to Propionibacterium species admitted to Mayo Clinic between January 1, 1990 and December 31, 2014. Patient charts were reviewed for clinical, microbiological, and imaging data. Descriptive analysis was performed. Results We identified 14 patients with CIED infection due to Propionibacterium species, accounting for 2.3% of all CIED infections. Patients were predominantly male (n=12, 86%). The median age at admission was 58.5 years [range, 22–83]. Twelve patients had implantable cardioverter-defibrillators (ICDs) and 2 had permanent pacemaker (PPM) systems. Twelve patients had generator pocket infection (86%). Two patients met clinical criteria for CIED-related infective endocarditis (CIED-IE). Median time between last device manipulation and infection was 9 months [range, 1–98]. All patients were treated with complete device removal and antibiotic therapy. Six-month follow-up data were available for 10 patients (71%), with no relapses documented. Conclusion CIED infections due to Propionibacterium species accounted for 2.3% of all device infections over a 25-year period. The most common infectious syndrome was generator pocket infection with delayed onset. There was an unanticipated predominance of ICDs in this cohort. Cure was achieved in all cases with complete device removal and antibiotic therapy.

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“…[ 26 ] The rate of SCD in dialysis patients, 41 per 1000 person-years in our study, was substantially higher than that reported in the general population [ 27 ]. Implantable cardioverter-defibrillators (ICDs) can prevent SCD but are associated with a higher risk of infection [ 28 , 29 ]. There are no randomized controlled data to guide primary prevention ICDs in this high risk population.…”

Section: Discussionmentioning

confidence: 99%

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

Kruzan

Herzog

et al. 2016

BMC Nephrol

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BackgroundSudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients.MethodsWe measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI).ResultsPatients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI.ConclusionsNTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users.

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Clinical Presentation and Outcomes of Cardiovascular Implantable Electronic Device Infections in Hemodialysis Patients

Cited by 36 publications

References 21 publications

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Cardiovascular Implantable Electronic Device Infections due toPropionibacteriumSpecies

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

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