Risk Factor Analysis of Permanent Pacemaker Infection

Abstract

Background. Several host- and procedure-related factors have been reported to increase the risk of permanent pacemaker (PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods.Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection.Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM-related endocarditis. Staphylococcus species (69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a permanent central venous catheter, the presence of >2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use (odds ratio [OR], 13.90; 95% confidence interval [CI], 1.27-151.7; P=.03) and the presence of >2 pacing leads versus 2 leads (OR, 5.41; 95% CI, 1.44-20.29; P=.01) as independent risk factors for PPM infection. In contrast, use of antibiotic prophylaxis prior to PPM implantation had a protective effect (OR, 0.087; 95% CI, 0.016-0.48; P=.005).Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

“…More complex systems have a higher infection risk and potential benefits from these systems should be weighed against lower infection risk with more simple systems. 4,18,21 Meticulous pre-operative preparation is necessary. Fever within 24 hours before implant is associated with a 5-6 fold infection risk, and diagnosis and treatment of ongoing infection before implantation is therefore important.…”

“…40 Observational data and meta-analyses support this finding. 4,18,19,41,42 Supporting evidence for using topical antibiotics is lacking; 43 however, recently a promising development has been introduced. The TYRX TM Envelope is an antibacterial envelope releasing minocycline and rifampin in the generator pocket after CIED implantation.…”

Percutaneous Atrial Septal Closure in Immunocompromised Patients

“…As patients who are immunocompromised or have an autoimmune disease are at higher risk of developing an infection [4,5,6], there is a concern that implanting a permanent foreign body in the vasculature might increase their risk of developing endocarditis. In addition, the healing process in these patients may be compromised, and some devices could be associated with a higher risk of erosion through a thin atrial wall.…”

Pacemaker Patients with High Level of Risk

“…Highly symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) irresponsive to medical therapy are treated with surgical myectomy, dual-chamber pacing or alcohol septal ablation (ASA) [1]. Based on single-center studies or national registries it seems that both short-and long-term outcomes of ASA are acceptable [2].…”

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Abstract:In this paper, Cardiac pacing is a safe and effective therapy for multiple bradyarrhythmic conditions [1]. However, incorrect perceptions about the safety of daily activities (SODA) may impair patients' absolute well-being [2].

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