ORIGINAL PAPER
Lead-dependent infective endocarditis and pocket infection – similarities and differences
Submission date: 2015-06-02
Final revision date: 2015-09-18
Acceptance date: 2015-09-21
Publication date: 2016-01-11
Medical Studies 2015;31(4):249-259
KEYWORDS
TOPICS
ABSTRACT
Introduction: Infectious complications in patients with implanted pacemakers are divided into infections of the generator pocket (PI) and lead-dependent infective endocarditis (LDIE).
Aim of the research: Identification of risk factors for developing different types of infections and evaluation of the extent of infectious complications.
Material and methods: We compared two groups of patients with infectious complications, who underwent transvenous lead extraction (TLE) in the Reference Centre between March 2006 and July 2013. The groups consisted of 414 patients with LDIE and 205 with PI. We analysed risk factors, clinical manifestations, inflammatory markers, microbiology, and echocardiography results.
Results: The coexistence of LDIE and PI was observed in 62.1% patients. There were no significant differences in the presence of host-dependent risk factors. Patients with LDIE significantly more frequently had abrasion of leads (35.1.% vs. 21.0%; p = 0.0001) connected with other procedural risk factors: a larger number of the leads (2.2 vs. 2.0; p = 0.004) lead loops (24.6% vs. 13.2%; p = 0.001), and longer time interval from the last procedure prior to TLE (28.7 vs. 22.6 months; p = 0.005). Fever and pulmonary infections, higher level of erythrocyte sedimentation rate, C-reactive protein, procalcitonin, vegetation presence, and higher pulmonary systolic pressure were also revealed in patients with LDIE. Positive blood and leads culture were observed in 34.5% and 46.4% patients with LDIE.
Conclusions: The frequent coexistence of LDIE and PI confirms their common pathogenesis, but the phenomenon of abrasion suggests also another mechanism for the development of LDIE. Intensity of clinical syndromes, high inflammatory parameters, echocardiography, and microbiology findings are helpful in assessment of the extensity of the infection.
Aim of the research: Identification of risk factors for developing different types of infections and evaluation of the extent of infectious complications.
Material and methods: We compared two groups of patients with infectious complications, who underwent transvenous lead extraction (TLE) in the Reference Centre between March 2006 and July 2013. The groups consisted of 414 patients with LDIE and 205 with PI. We analysed risk factors, clinical manifestations, inflammatory markers, microbiology, and echocardiography results.
Results: The coexistence of LDIE and PI was observed in 62.1% patients. There were no significant differences in the presence of host-dependent risk factors. Patients with LDIE significantly more frequently had abrasion of leads (35.1.% vs. 21.0%; p = 0.0001) connected with other procedural risk factors: a larger number of the leads (2.2 vs. 2.0; p = 0.004) lead loops (24.6% vs. 13.2%; p = 0.001), and longer time interval from the last procedure prior to TLE (28.7 vs. 22.6 months; p = 0.005). Fever and pulmonary infections, higher level of erythrocyte sedimentation rate, C-reactive protein, procalcitonin, vegetation presence, and higher pulmonary systolic pressure were also revealed in patients with LDIE. Positive blood and leads culture were observed in 34.5% and 46.4% patients with LDIE.
Conclusions: The frequent coexistence of LDIE and PI confirms their common pathogenesis, but the phenomenon of abrasion suggests also another mechanism for the development of LDIE. Intensity of clinical syndromes, high inflammatory parameters, echocardiography, and microbiology findings are helpful in assessment of the extensity of the infection.
REFERENCES (25)
1.
Voigt A, Shalaby A, Saba S. Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol 2010; 33: 414-9.
2.
Cabell CH, Heidenreich PA, Chu VH, et al. Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999. Am Heart J 2004; 147: 582-6.
3.
Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007; 49: 1851-9.
4.
Greenspon AJ, Patel JD, Lau E, et al. 16-Year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008.
6.
Habib G, Hoen B, Tornos P, et al. ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30: 2369-413.
7.
Sohail MR, Uslan DZ, Khan AH, et al Infective endocarditis complicating permanent pacemaker and implantable cardioverter defibrillator infection. Mayo Clin Proc 2008; 83: 46-53.
8.
Bongiorni MG, Marinskis G, Lip GY, et al. How European centres diagnose, treat, and prevent CIED infections: results of an European Heart Rhythm Association survey. Europace 2012; 14: 1666-9.
9.
Golzio PG, Fanelli AL, Vinci M, et al. Lead vegetations in patients with local and systemic cardiac device infections: prevalence, risk factors, and therapeutic effects. Europace 2013; 15: 89-100.
10.
Tarakji KG, Chan EJ, Cantillon DJ, et al. Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart Rhythm 2010; 7: 1043-7.
11.
Clinical cardiac pacing, defibrillation, and resynchronization therapy. Ellenbogen KA, Kay GN, Lau CP, Wilkoff BL (eds.). Saunders Elsevier, Philadelphia 2007; 912-30.
12.
Durante-Mangoni E, Mattucci I, Agrusta F, et al. Current trends in the management of cardiac implantable electronic device (CIED) infections. Intern Emerg Med 2013; 8: 465-76.
13.
Deharo JC, Quatre A, Mancini J, et al. Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study. Heart 2012; 98: 724-9.
14.
Viganego F, O’Donoghue S, Eldadah Z, et al. Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections. Am J Cardiol 2012; 109: 1466-71.
15.
Nery PB, Fernandes R, Nair GM, et al. Device-related infection among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences. J Cardiovasc Electrophysiol 2010; 21: 786-90.
16.
Ipek EG, Guray U, Demirkan B, et al. Infections of implantable cardiac rhythm devices: predisposing factors and outcome. Acta Cardiol 2012; 67: 303-10.
17.
Kutarski A, Małecka B. Przetarcie silikonowych izolacji elektrod wewnątrzsercowych – nowo odkryte zjawisko w elektroterapii: obserwacje własne. Folia Cardiol Exc 2009; 4: 126-31.
18.
Kołodzińska A, Kutarski A, Kozłowska M, et al. Biodegradation of the outer silicone insulation of endocardial leads. Circ Arrhythm Electrophysiol 2013; 6: 279-86.
19.
Chatelain P, Adamec R, Cox JN. Morphological changes in human myocardium during permanent pacing. Virchows Arch (Pathol Anat) 1985; 407: 43-57.
20.
Massoure PL, Reuter S, Lafitte S, et al. Pacemaker endocarditis: clinical features and management of 60 consecutive cases. Pacing Clin Electrophysiol 2007; 30: 12-9.
21.
Sarrazin JF, Philippon F, Tessier M, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol 2012; 59: 1616-25.
22.
Athan E, Chu VH, Tattevin P, et al. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA 2012; 307: 1727-35.
23.
Schmitt CG, Ellringmann U, Köhler F. Experiences with transvenously implanted pacemaker electrodes with special remarks on the treatment of leads out of function. Z Kardiol 1977; 66: 447-53.
24.
Bongiorni MG, Tascini C, Tagliaferri E, et al. Microbiology of cardiac implantable electronic device infections. Europace 2012; 14: 1334-9.
25.
Greenspon AJ, Rhim ES, Mark G, et al. Lead-associated endocarditis: the important role of methicillin-resistant Staphylococcus aureus. Pacing Clin Electrophysiol 2008; 31: 548-53.
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
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