Thomas A Boyle1, Daniel Z Uslan2, Jordan M Prutkin2, Arnold J Greenspon2, Larry M Baddour2, Stephan B Danik2, Jose M Tolosana2, Katherine Le2, Jose M Miro2, James Peacock2, Muhammad R Sohail2, Holenarasipur R Vikram2, Roger G Carrillo1. 1. From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.). tab127@miami.edu rcarrillo@med.miami.edu. 2. From the Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, FL (T.A.B.); Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles (D.Z.U.); Department of Medicine, Division of Cardiology, University of Washington, Seattle (J.M.P.); Department of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.); Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN (L.M.B., K.L., M.R.S.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston (S.B.D.); Department of Medicine, Division of Infectious Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Spain (J.M.T., J.M.M.); Department of Medicine, Division of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC (J.P.); and Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ (H.R.V.).
Abstract
BACKGROUND: Infection is a serious complication of cardiovascular-implantable electronic device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanting hardware after infection vary widely and have not previously been analyzed using a large, multicenter study. METHODS AND RESULTS: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with cardiovascular-implantable electronic device infections at multiple institutions in the United States and abroad between 2009 and 2012. Reimplantation strategies were evaluated overall, and every patient who relapsed within 6 months was individually examined for clinical information that could help explain the negative outcome. Overall, 434 patients with cardiovascular-implantable electronic device infections were prospectively enrolled at participating centers. During the initial course of therapy, complete device removal was done in 381 patients (87.8%), and 220 of them (57.7%) were ultimately reimplanted with new devices. Overall, the median time between removal and reimplantation was 10 days, with an interquartile range of 6 to 19 days. Eleven of the 434 patients had another infection within 6 months, but only 4 of them were managed with cardiovascular-implantable electronic device removal and reimplantation during the initial infection. Thus, the repeat infection rate was low (1.8%) in those who were reimplanted. Patients who retained original hardware had a 11.3% repeat infection rate. CONCLUSIONS: Our study findings confirm that a broad range of reimplant strategies are used in clinical practice. They suggest that it is safe to reimplant cardiac devices after extraction of previously infected hardware and that the risk of a second infection is low, regardless of reimplant timing.
BACKGROUND: Infection is a serious complication of cardiovascular-implantable electronic device implantation and necessitates removal of all hardware for optimal treatment. Strategies for reimplanting hardware after infection vary widely and have not previously been analyzed using a large, multicenter study. METHODS AND RESULTS: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with cardiovascular-implantable electronic device infections at multiple institutions in the United States and abroad between 2009 and 2012. Reimplantation strategies were evaluated overall, and every patient who relapsed within 6 months was individually examined for clinical information that could help explain the negative outcome. Overall, 434 patients with cardiovascular-implantable electronic device infections were prospectively enrolled at participating centers. During the initial course of therapy, complete device removal was done in 381 patients (87.8%), and 220 of them (57.7%) were ultimately reimplanted with new devices. Overall, the median time between removal and reimplantation was 10 days, with an interquartile range of 6 to 19 days. Eleven of the 434 patients had another infection within 6 months, but only 4 of them were managed with cardiovascular-implantable electronic device removal and reimplantation during the initial infection. Thus, the repeat infection rate was low (1.8%) in those who were reimplanted. Patients who retained original hardware had a 11.3% repeat infection rate. CONCLUSIONS: Our study findings confirm that a broad range of reimplant strategies are used in clinical practice. They suggest that it is safe to reimplant cardiac devices after extraction of previously infected hardware and that the risk of a second infection is low, regardless of reimplant timing.
Authors: David Zweiker; Francesco Melillo; Giuseppe D'Angelo; Andrea Radinovic; Alessandra Marzi; Lorenzo Cianfanelli; Savino Altizio; Luca R Limite; Gabriele Paglino; Antonio Frontera; Kenzaburo Nakajima; Luigia Brugliera; Lorenzo Malatino; Paolo Della Bella; Patrizio Mazzone Journal: J Arrhythm Date: 2022-02-04
Authors: C Steinwender; P Lercher; C Schukro; H Blessberger; G Prenner; M Andreas; J Kraus; M Ammer; M Stühlinger Journal: J Interv Card Electrophysiol Date: 2019-12-20 Impact factor: 1.900
Authors: Mikhael F El-Chami; Jens Brock Johansen; Amir Zaidi; Svein Faerestrand; Dwight Reynolds; Javier Garcia-Seara; Jacques Mansourati; Jean-Luc Pasquie; Hugh Thomas McElderry; Paul R Roberts; Kyoko Soejima; Kurt Stromberg; Jonathan P Piccini Journal: J Cardiovasc Electrophysiol Date: 2019-01-28