Vassil Traykov1, Maria Grazia Bongiorni2, Giuseppe Boriani3, Haran Burri4, Roberto Costa5, Nikolaos Dagres6, Jean-Claude Deharo7, Laurence M Epstein8, Paola Anna Erba9, Ulrika Snygg-Martin10, Jens Cosedis Nielsen11, Jeanne E Poole12, Laszlo Saghy13, Christoph Starck14, Neil Strathmore15, Carina Blomström-Lundqvist16. 1. Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria. 2. Cardiology and Arrhythmology Division, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy. 3. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. 4. Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland. 5. Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil. 6. Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany. 7. Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France. 8. System Director, Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA. 9. Department of Translational Research and New Technology in Medicine, University of Pisa, AOUP, Italy and Department on Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 10. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 11. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 12. University of Washington, Cardiology, Seattle, WA, USA. 13. Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary. 14. Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. 15. Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia. 16. Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden.
Abstract
AIMS: Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. METHODS AND RESULTS: A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively. CONCLUSION: Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. METHODS AND RESULTS: A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively. CONCLUSION: Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Giuseppe Boriani; Marco Proietti; Matteo Bertini; Igor Diemberger; Pietro Palmisano; Stefano Baccarini; Francesco Biscione; Nicola Bottoni; Antonio Ciccaglioni; Alessandro Dal Monte; Franco Alberto Ferrari; Saverio Iacopino; Marcello Piacenti; Daniele Porcelli; Stefano Sangiorgio; Luca Santini; Michele Malagù; Giuseppe Stabile; Jacopo Francesco Imberti; Davide Caruso; Massimo Zoni-Berisso; Roberto De Ponti; Renato Pietro Ricci Journal: J Pers Med Date: 2022-01-11