TY - JOUR
T1 - Rate, Time Course, and Predictors of Implantable Cardioverter Defibrillator Infections
T2 - An Analysis From the SIMPLE Trial
AU - Philippon, François
AU - O'Hara, Gilles E.
AU - Champagne, Jean
AU - Hohnloser, Stefan H.
AU - Glikson, Michael
AU - Neuzner, Jörg
AU - Mabo, Philippe
AU - Vinolas, Xavier
AU - Kautzner, Josef
AU - Gadler, Fredrik
AU - Lashevsky, Noa
AU - Connolly, Stuart J.
AU - Liu, Yan Y.
AU - Healey, Jeff S.
N1 - Publisher Copyright:
© 2020 Canadian Cardiovascular Society
PY - 2020/9
Y1 - 2020/9
N2 - Background: The number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors. Methods: The Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics. Results: Within 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection. Conclusions: This cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection.
AB - Background: The number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors. Methods: The Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics. Results: Within 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection. Conclusions: This cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection.
UR - http://www.scopus.com/inward/record.url?scp=85089443353&partnerID=8YFLogxK
U2 - 10.1016/j.cjco.2020.04.008
DO - 10.1016/j.cjco.2020.04.008
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C2 - 32995720
AN - SCOPUS:85089443353
SN - 2589-790X
VL - 2
SP - 354
EP - 359
JO - CJC Open
JF - CJC Open
IS - 5
ER -