期刊
HEART RHYTHM
卷 11, 期 4, 页码 595-601出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2013.12.013
关键词
Cardiac implantable electronic device; Infection
资金
- TyRx Pharmaceuticals
BACKGROUND Cardiac implantable electronic device (CIED) infection is associated with morbidity and mortality. OBJECTIVES To determine the incidence and risk factors for CIED infection, to develop a scoring index for risk stratification, and to analyze the effect of the AIGIS(RX) envelope on infection rates. METHODS Consecutive patients who underwent a CIED procedure were identified and surveyed for 6 months for the development of an infection necessitating removal of all implanted hardware. RESULTS In the pre-envelope era, an infection occurred in 25 (1.5%) of 1651 patients. After its availability, an envelope was used in 275 (22%) of 1240 patients; an infection occurred in 8 (0.6%) patients in this era (P = .029 vs pre-envelope). In the overall cohort of 2891 patients, the infection rate was 1.2% and 3.5% in patients with an implantable cardioverter-defibrillator device and those with a cardiac resynchronization therapy defibrillator device, respectively (P = .018); in these patients, 7 independent risk factors predicted infection: early pocket re-exploration, male sex, diabetes, upgrade procedure, heart failure, hypertension, and glomerular filtration rate < 60 mL/min. A composite risk score (0-25; C index 0.72; 95% confidence interval 0.61-0.83) was created by weight, adjusting these 7 factors: 3 groups emerged- low risk (score 0-7; 1% infection), medium risk (score 8-14; 3.4% infection), and high risk (score >= 15; 11.1% infection). The envelope reduced infections by 79% and 100% in the medium- and high-risk groups, respectively. CONCLUSIONS CIED infection most commonly occurred in patients with an implantable cardioverter-defibrillator device and those with a cardiac resynchronization therapy defibrillator device. A composite score based on clinical variables appeared feasible for infection risk stratification. The AIGIS(RX) envelope significantly lowered the risk of CIED infection. Randomized clinical data are warranted.
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