Epidemiology of cardiac implantable electronic device infections in the United States: A population-based cohort study

Rennert-May, Elissa; Chew, Derek S.; Lu, Shengjie; Chú, Ángel; Kuriachan, Vikas; Somayaji, Ranjani

doi:10.1016/j.hrthm.2020.02.012

Cited by 30 publications

(21 citation statements)

References 13 publications

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“…The resultant healthcare costs are therefore substantial ( Table 2 ), although this varies according to geographic region, type of CIED, and associated management decision. 4 , 5 , 11 , 29 , 41 , 43–46 Costs related to medical care include hospitalization, procedural (both extraction and reimplantation of replacement device), physician service, outpatient care, and associated investigations and medications. 5 , 41 , 42 , 44 In addition, the provision of sick pay contributes to the societal burden of CIED infections.…”

Section: Healthcare Consequencesmentioning

confidence: 99%

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

et al. 2021

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Epidemiology of CIED Infections: Incidence and Risk Factors 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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Section: Healthcare Consequencesmentioning

confidence: 99%

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

et al. 2021

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“…We considered pacemaker implantation based on the diagnosis of CI; however, there was no guarantee that cardiac pacing would clear her symptoms despite the invasive nature of the therapy and possible short‐ and long‐term complications 7 . This uncertainty was why the patient was not convinced of the efficacy of pacemaker implantation.…”

Section: Discussionmentioning

confidence: 99%

Case report: “A healthy woman with exertional dyspnea: Indication of a pacemaker or not?”

Clasen

Schmidt

Bejinariu

et al. 2023

Pacing Clinical Electrophis

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The selection of patients with chronotropic incompetence (CI) for cardiac pacing therapy remains challenging. Here, we present a case of a 40-year-old woman with severe exertional dyspnea. The exercise test revealed a blunted increase in the heart rate (HR) (maximum of 110 bpm). Her exercise capacity significantly improved under atrial stimulation at 170 bpm using a temporary pacing lead. Therefore, we implanted a rateadaptive dual-chamber pacemaker with a blended sensor. During follow-up exercise capacity normalized, and she had no residual exertional dyspnea at 6 months. This case highlights the potential value for individual assessments of CI to identify clear indications for pacemaker implantation.

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“… 21 , 38 Finally, end-stage renal disease is one of the most powerful determinants of risk for CIED infection, but perhaps that risk will not be significantly impacted by an intervention with demonstrable effect against pocket infection, but no significant effect on endovascular infection. 15 , 16 , 21 , 32 , 39 Future studies including planned analyses of the WRAP-IT data should further clarify the role of AEs.…”

Section: Defining High Riskmentioning

confidence: 99%

Antibiotic eluting envelopes: evidence, technology, and defining high-risk populations

2021

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Cardiovascular implantable electronic devices (CIED) are effective and important components of modern cardiovascular care. Despite the dramatic improvements in the functionality and reliability of these devices, over time patients are at risk for developing several morbidities, the most feared of which are local and systemic infections. Despite significant financial investment and aggressive therapy with hospitalization, intravenous antibiotics, and transvenous lead extraction, the outcomes include a 1-year mortality rate as high as 25%. This risk of infection has increased over time, likely due to the increased complexity of the surgical interventions required to insert and replace these devices. The only way to reduce this morbidity and mortality is to prevent these infections, and other than preoperative antibiotics, there were little data supporting effective therapy until the WRAP-IT trial provided randomized data showing that pocket infections can be reduced by 60% at 12 months and major CIED infections reduced by 40% at 1 year with the use of the absorbable antibiotic eluting envelope in patient CIED procedures at high risk of infection. Not all CIED procedures are at high risk of infection and justify the use of the envelope, but cost-effectiveness data support the use of the antibiotic envelope particularly in patients with defibrillator replacements, revisions, and upgrades, such as to a resynchronization device and in patients with prior CIED infection, history of immunocompromise, two or more prior procedures, or a history of renal dysfunction.

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Epidemiology of cardiac implantable electronic device infections in the United States: A population-based cohort study

Cited by 30 publications

References 13 publications

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

Epidemiology of cardiac implantable electronic device infections: incidence and risk factors

Case report: “A healthy woman with exertional dyspnea: Indication of a pacemaker or not?”

Antibiotic eluting envelopes: evidence, technology, and defining high-risk populations

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