Incidence of and risk factors for infectious complications in patients with cardiac device implantation

• Main Authors: Hea Won Ann, Jin Young Ahn, Yong Duk Jeon, In Young Jung, Su Jin Jeong, Boyoung Joung, MoonHyoung Lee, Nam Su Ku, Sang Hoon Han, June Myung Kim, Jun Yong Choi
• Format: Article
• Language: English
• Published: Elsevier 2015-07-01
• Series: International Journal of Infectious Diseases
• Subjects: ICD; CRT; Pacemaker; CIED; infection
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971215001198

Objectives: The use of cardiac implantable electronic device (CIED; pacemakers, implantable cardioverter-defibrillators [ICD], cardiac re-synchronized therapy [CRT]) implantation, one essential treatment for cardiac arrhythmias, is increasing. Infectious complications related to implants are the main reason for device removal and patient morbidity. We sought to identify the incidence of infectious complications among patients with cardiac device implantation and analyze the risk factors for infectious complications. Methods: A retrospective analysis was conducted of 1307 patients (61.5±14.2 years-old, 49.6% male) with cardiac device implantation from January 1990 to April 2013. We analyzed the incidence of infectious complications during the follow-up period. To investigate risk factors associated with infectious complications, we conducted a 1:2 matched case-control study of patients with infectious complications and controls without infectious complications who had the same implantation period and physician. Results: Among 1307 patients, 12 had a confirmed device-related infection: 7 with a pocket infection and 5 with infective endocarditis. Over a total of 9091.9 device-years, the incidence of infectious complications was 1.3/1000 device-years, based on the 12 patients with an infection. ICD (5.1/1000 device-year) had a higher incidence of infectious complications than other cardiac devices, and no infectious complications were observed among patients with CRT implantation. Mean duration from the time of implantation to infection was 2.02±1.65 years. In a multivariate analysis, the number of prior procedures including wound revision or scar revision was an independent risk factor for infectious complications (OR=10.88, 95% CI 1.11->999, p=0.040). Conclusions: Infection was a rare complication of cardiac device implantation, but repeated procedures were associated with infectious complications.