Cardiac implantable electronic device implantation and device-related infection

Vivek Modi; Kashyap Shah; Bruce Ferraro; Leyla Gasimli-Gamache; Sudip Nanda; Steven Stevens; Jamshid Shirani

doi:10.1093/europace/euad208

Cardiac implantable electronic device implantation and device-related infection

Europace. 2023 Aug 2;25(9):euad208. doi: 10.1093/europace/euad208.

Authors

Vivek Modi¹, Kashyap Shah¹, Bruce Ferraro¹, Leyla Gasimli-Gamache¹, Sudip Nanda¹, Steven Stevens¹, Jamshid Shirani¹

Affiliation

¹ Department of Cardiology, St. Luke's University Health Network, Heart and Vascular Center, 801 Ostrum Street, Bethlehem, PA 18015, USA.

Abstract

Aims: Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device-related infections (DRI) remain a significant complication of CIED and are associated with major adverse outcomes. We aimed to assess the trend in CIED implantations, and the burden and morbidity associated with DRI.

Methods and results: The 2011-2018 National Inpatient Sample database was searched for admissions for CIED implantation and DRI. A total of 1 604 173 admissions for CIED implantations and 71 007 (4.4%) admissions for DRI were reported. There was no significant change in annual admission rates for DRI (3.96-4.59%, P value for trend = 0.98). Those with DRI were more likely to be male (69.3 vs. 57%, P < 0.001) and have a Charlson comorbidity index score ≥3 (46.6 vs. 36.8%, P < 0.001). The prevalence of congestive heart failure (CHF) increased in those admitted with DRI over the observation period. Pulmonary embolism, deep vein thrombosis, and post-procedural hematoma were the most common complications in those with DRI (4.1, 3.6, and 2.90%, respectively). Annual in-hospital mortality for those with DRI ranged from 3.9 to 5.8% (mean 4.4%, P value for trend = 0.07). Multivariate analysis identified CHF [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.35-2.07], end-stage renal disease (OR = 1.90; 95% CI = 1.46-2.48), coagulopathy (OR = 2.94; 95% CI = 2.40-3.61), and malnutrition (OR = 2.50; 95% CI = 1.99-3.15) as the predictors of in-hospital mortality for patients admitted with DRI.

Conclusion: Device-related infection is relatively common and continues to be associated with high morbidity and mortality. The prevalence of DRI has not changed significantly despite technical and technological advances in cardiac devices and their implantation.

Keywords: Cardiac implantable electronic device; Cost; Device-related infection; Length of stay; Mortality; Prognosis.

MeSH terms

Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / epidemiology
Arrhythmias, Cardiac / therapy
Defibrillators, Implantable* / adverse effects
Female
Heart Failure* / complications
Heart Failure* / epidemiology
Heart Failure* / therapy
Hospitalization
Humans
Male
Pacemaker, Artificial* / adverse effects
Prosthesis-Related Infections* / diagnosis
Prosthesis-Related Infections* / epidemiology
Prosthesis-Related Infections* / etiology
Retrospective Studies
Risk Factors