Effect of Early Diagnosis and Treatment With Percutaneous Lead Extraction on Survival in Patients With Cardiac Device Infections

Viganego, Federico; O’Donoghue, Susan; Eldadah, Zayd; Shah, Manish H.; Rastogi, Mohit; Mazel, Jay A.; Platia, Edward V.

doi:10.1016/j.amjcard.2012.01.360

Cited by 94 publications

(36 citation statements)

References 18 publications

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“…newly discovered phenomenon of intracardiac abrasion of the leads. Some reports showed more infections in patients with dual‐ and triple‐chamber devices as compared with single‐chamber ones, and a higher probability of infection in patients with CRT or ICD than in those with PM . Other findings did not support the previous research .…”

Section: Discussionmentioning

confidence: 65%

“…The present analysis confirmed the increased frequency of LDIE in patients with chronic RF. Other risk factors for developing infectious complications are older age (younger age in some studies), male gender, heart failure, diabetes mellitus, anticoagulation therapy, corticosteroid therapy, chronic obstructive pulmonary disease, and malignant neoplasms . Most studies did not identify individual factors directly affecting the development of LDIE; most often infectious complications were evaluated jointly.…”

Section: Discussionmentioning

confidence: 99%

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Lead‐Dependent Infective Endocarditis: The Role of Factors Predisposing to Its Development in an Analysis of 414 Clinical Cases

Polewczyk

Jacheć

Janion

et al. 2015

Pacing Clinical Electrophis

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The factors predisposing to LDIE are mainly related to procedures performed on the patients. LDIE develops more frequently in patients with multiple leads, especially ICD. An important, until now lesser known, risk factor for LDIE is intracardiac abrasion of the leads strongly connected with procedural agents and properties of specific kind of bacteries. A new concept of the pathogenesis of LDIE was proposed on the basis of present analysis.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Lead‐Dependent Infective Endocarditis: The Role of Factors Predisposing to Its Development in an Analysis of 414 Clinical Cases

Polewczyk

Jacheć

Janion

et al. 2015

Pacing Clinical Electrophis

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show abstract

“…It concerns mainly isolated LDIE, as the coexistent pocket infection prompts extended diagnostics in search for LDIE. Moreover, available reports on LDIE comprised small numbers of patients, from 10 to 88 in single-center studies, and from 145 to 177 in multicenter registries [9, 10, 13–20]. For this reason, the clinical manifestations of LDIE remain vague and necessitate further research.…”

Section: Introductionmentioning

confidence: 99%

Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

Polewczyk

Janion

Podlaski

et al. 2014

Eur J Clin Microbiol Infect Dis

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It is important to identify clinical manifestations of lead-dependent infective endocarditis (LDIE), as it begins insidiously with the slow development of nonspecific symptoms. Clinical data from 414 patients with the diagnosis of LDIE according to Modified Duke Lead Criteria (MDLC) were analyzed. Patients with LDIE had been identified in a population of 1,426 subjects submitted to transvenous lead extraction (TLE) in the Reference Clinical Cardiology Center in Lublin between 2006 and 2013. The symptoms of LDIE and pocket infection were detected in 62.1 % of patients. The mean duration of LDIE symptoms prior to referral for TLE was 6.7 months. Fever and shivers were found in 55.3 % of patients, and pulmonary infections in 24.9 %. Vegetations were detected in 67.6 % of patients, and positive cultures of blood, lead, and pocket in 34.5, 46.4, and 30.0 %, respectively. The most common pathogens in all type cultures were coagulase-negative staphylococci (CNS), with Staphylococcus epidermidis domination; the second most common organism was Staphylococcus aureus. 76.3 % of patients were treated with empirical antibiotic therapy before hospitalization due to TLE. In the laboratory tests, the mean white blood cell count was 9,671 ± 5,212/μl, mean erythrocyte sedimentation rate 43 mm, C-reactive protein (CRP) 46.3 mg/dl ± 61, and procalcitonin 1.57 ± 4.4 ng/ml. The multivariate analysis showed that the probability of LDIE increased with increasing CRP. The diagnosis of LDIE based on MDLC may be challenging because of a relatively low sensitivity of major criteria, which is associated with early antibiotic therapy and low usefulness of minor criteria. The important clinical symptoms of LDIE include fever with shivering and recurrent pulmonary infections. The most specific pathogens were Staphylococcus epidermidis and Staphylococcus aureus. Laboratory tests most frequently revealed normal white blood cell count, relatively rarely elevated procalcitonin level, and significantly increased erythrocyte sedimentation rate (ESR) and CRP. This constellation of signs should prompt a more thorough search for LDIE.

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“…Mortality with endocarditis is reported between 24.5 % and 29.0 %, 31,71,77 and CIED infections with endocarditis have a higher mortality than pocket infection. 3,78 One study found a 6-month mortality of 10.1 % after system removal in patients with small lead vegetations and 18.4 % in patients with large lead vegetations. 31 System extraction is associated with a small risk of major complications, particularly vascular lacerations causing haemothorax and death.…”

Section: Outcomes Of Cardiac Implantable Electronic Device Infectionmentioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations in ‘higher risk’ candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important. Diagnosis is often difficult and delayed by subtle signs of infection. Treatment of CIED infection includes complete system removal in centres experienced in CIED extraction and prolonged antibiotic therapy. Meticulous planning and preparation before system extraction and later CIED re-implantation is essential for better patient outcome. Future strategies for reducing CIED infection should be tested in sufficiently powered, multicentre, randomised controlled trials

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Effect of Early Diagnosis and Treatment With Percutaneous Lead Extraction on Survival in Patients With Cardiac Device Infections

Cited by 94 publications

References 18 publications

Lead‐Dependent Infective Endocarditis: The Role of Factors Predisposing to Its Development in an Analysis of 414 Clinical Cases

Lead‐Dependent Infective Endocarditis: The Role of Factors Predisposing to Its Development in an Analysis of 414 Clinical Cases

Clinical manifestations of lead-dependent infective endocarditis: analysis of 414 cases

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

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