Mingyan Dai1, Cheng Cai2, Vaidya Vaibhav3, M Rizwan Sohail4, David L Hayes3, David O Hodge5, Ying Tian6, Roshini Asirvatham3, Jordan J Cochuyt5, Congxin Huang7, Paul A Friedman3, Yong-Mei Cha8. 1. Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China; Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. 2. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 3. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. 4. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Department of Internal Medicine, Division of Infectious Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. 5. Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. 6. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Department of Cardiology, Beijing Chaoyang Hospital, Beijing, China. 7. Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China. 8. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. Electronic address: ycha@mayo.edu.
Abstract
OBJECTIVES: This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study. BACKGROUND: Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs. METHODS: We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation. RESULTS: The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection. CONCLUSIONS: The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
OBJECTIVES: This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study. BACKGROUND: Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs. METHODS: We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation. RESULTS: The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection. CONCLUSIONS: The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
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