Increased Long‐Term Mortality in Patients with Cardiovascular Implantable Electronic Device Infections

Sohail, M. Rizwan; Henrikson, Charles A.; Braid-Forbes, Mary Jo; Forbes, Kevin F.; Lerner, Daniel J.

doi:10.1111/pace.12518

Cited by 90 publications

(42 citation statements)

References 15 publications

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“…This response is also not unexpected, as postoperative CIED infection caries an alarmingly high morbidity and mortality approaching 5% with long-term effects that can last up to 3 years, dependent on the type of device. [12][13][14][15][16] In this study, of the 10 patients (0.8%) who developed a definite infection after CIED implant (within 60 days), only one had a preoperative WBC count which was elevated (11.7 × 10 3 /uL) and in fact the highest WBC count (29 × 10 3 /uL) was noted in a patient without infection. The overall preoperative WBC count between the two groups (those with and without infection) was not found to be of statistical significance.…”

Section: Although Not Specifically Indicated Preoperative Laboratorymentioning

confidence: 55%

“…Despite this, however, the well‐established notion of leukocytosis as a representation of infection leads to trepidation on part of the implanting physician. This response is also not unexpected, as postoperative CIED infection caries an alarmingly high morbidity and mortality approaching 5% with long‐term effects that can last up to 3 years, dependent on the type of device …”

Section: Discussionmentioning

confidence: 99%

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Significance of leukocytosis prior to cardiac device implantation

Kumar

Tompkins

Veenhuyzen

et al. 2018

Pacing Clinical Electrophis

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Section: Although Not Specifically Indicated Preoperative Laboratorymentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Significance of leukocytosis prior to cardiac device implantation

Kumar

Tompkins

Veenhuyzen

et al. 2018

Pacing Clinical Electrophis

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“…Device infection is associated with increased mortality in patients receiving CIED therapy . Some investigators have reported that CIED recipients who develop device infection have increased, device‐dependent, long‐term mortality even after successful treatment of infection .…”

Section: Managing Cied Infectionmentioning

confidence: 99%

Managing infected cardiovascular implantable electronic devices

Manolis¹,

Melita

2016

Continuing Cardiol Educ

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The number of cardiac implantable electronic device (CIED) implants is growing; unfortunately, the rate of device infections is also rising, outpacing the increase in device implantation and paralleling the complexity of current CIEDs and CIED recipients, incurring high morbidity and mortality, long hospital stays, and increased financial cost. For either pocket or lead infection, percutaneous complete removal of the infected device and lead system combined with prolonged antibiotic treatment is the standard approach to patient management. A variety of mechanical and/or laser‐assisted techniques and tools are employed with high success rates in experienced centers. Surgery is reserved for cases with very large vegetations, need for other concomitant cardiac surgery or for failed or complicated percutaneous approach. Following removal of an infected CIED, the need for reimplantation of a new device is individualized, although the timing is variable, mainly based on the absence of signs of continued infection. In general, CIED‐related infective endocarditis and the presence of comorbid conditions are associated with increased mortality. These and other important relevant issues of contemporary management of patients with infected CIEDs are herein reviewed. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4596336/Activity.aspx

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“…Thus, in the past, not infrequently, leads or remaining lead fragments were left behind after HTX. Prior studies have shown that immunosuppressive therapy represents a significant risk factor for pacemaker infections, and thus remaining lead fragments pose a high risk for potentially life‐threatening complications after transplantation 6,7 . After a transplant, patients require a lifetime, precisely tuned, immunosuppressive therapy, which needs constant medical attention to minimize the risk of rejection.…”

Section: Introductionmentioning

confidence: 99%

Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments

Hahnel

Pecha²,

Bernhardt³

et al. 2020

Cardiovasc electrophysiol

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Background Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX. Methods and Results Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X‐ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%. Conclusion Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance.

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Increased Long‐Term Mortality in Patients with Cardiovascular Implantable Electronic Device Infections

Abstract: CIED recipients who develop device infection have increased, device-dependent, long-term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.

Cited by 90 publications

References 15 publications

Significance of leukocytosis prior to cardiac device implantation

Significance of leukocytosis prior to cardiac device implantation

Managing infected cardiovascular implantable electronic devices

Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments

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