Risk Factors Related to Infections of Implanted Pacemakers and Cardioverter-Defibrillators

Klug, Didier; Baldé, Mamadou Dadhi; Pavin, Dominique; Hidden‐Lucet, Françoise; Clémenty, Jacques; Sadoul, Nicolas; Rey, Jean‐Luc; Lande, Gilles; Lazarus, Arnaud; Victor, Jacques; Barnay, C; Grandbastien, Bruno; Kacet, Salem

doi:10.1161/circulationaha.106.678664

Cited by 646 publications

(567 citation statements)

References 22 publications

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“…In most cases, temporary pacing is chosen; however, presence of a temporary pacing lead is also associated with a higher infection risk. 19,37 Indwelling lines (e.g. central venous catheters and chest tubes) should be removed before CIED implantation.…”

Section: Before Implantationmentioning

confidence: 99%

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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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Section: Before Implantationmentioning

confidence: 99%

“…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.…”

Section: Peri-operativementioning

confidence: 99%

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Kirkfeldt¹,

Johansen²,

Nielsen³

2016

Arrhythmia &Amp; Electrophysiology Review

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease. Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3-6 months or telephone questionnaire up to 8 years later. Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.

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“…20 In a separate study, the mean time between implantation and explantation for device infection was 52 days. 21 So, logically, some of these explanted devices should have adequate residual battery life for reuse, and after resterilization, may be a potential source of recycled devices. Sometimes, the pacemakers are replaced by biventricular pacemakers or ICDs.…”

Section: Disposal Of Cardiac Rhythm Control Devicesmentioning

confidence: 99%

Reuse of Cardiac Rhythm Control Devices: A Review

et al. 2013

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Cardiac rhythm control devices i.e. pacemakers, implantable cardioverter-defibrillators (ICDs) and biventricular pacemakers are at times lifesaving treatment and prevention of arrhythmia. But, despite definite indications, many people in the developing countries cannot afford these devices due to high cost, and succumb to premature death. On the other hand, after implantation, pacemakers and ICDs are sometimes underutilized because of premature explantation due to death of the recipient, device infection, or upgradation, leaving a considerable extent of serviceable battery life unused. Majority of these explanted devices are simply thrown away. Though made for single use, a growing body of evidence indicates the safety, efficacy and feasibility of reimplantation of the prematurely explanted devices in patient in need who is otherwise unable to afford a new one. Patients, physicians, morticians, and even the general public support the idea of device donation and recycling. A number of organizations around the world have engaged themselves in this benevolent effort, and t he feasibility of device reutilization programme has already been established. However, some logistic, legal and ethical concerns are yet to be solved. The statutory bodies and professional organizations should address the issue of device recycling to solve the unsolved issues and formulate standard practice guidelines. In that case, such medical wastes may turn into invaluable resources, and help ensuring equitable medical care throughout the world. Cardiovascular Journal Volume 6, No. 1, 2013, Page 52-59 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16116

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Risk Factors Related to Infections of Implanted Pacemakers and Cardioverter-Defibrillators

Cited by 646 publications

References 22 publications

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Management of Cardiac Electronic Device Infections: Challenges and Outcomes

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Reuse of Cardiac Rhythm Control Devices: A Review

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