Abstract 15222: Pacemaker Or Implantable Cardioverter-defibrillator Related Infection: Risks Factors Of Recurrences In A Prospective Cohort
Risk factors for recurrences in patients after cardiac-device related infection (DRI) management are limited and several questions remain for an optimal management of DRI. We evaluated the prognostic significance of key clinical variables in a large prospective cohort of patients with algorithms of DRI diagnosis and management.
Design: 594 consecutive patients were referred for DRI. Material removal was systematically proposed. In pacing-dependent patients, an epicardial pacing system was inserted before extraction of the prior pacing system. In the other cases, if indicated, a new transvenous device was implanted 15-60 days later. Antibiotics were administered intravenously for 2 weeks after lead removal, then orally for 4 weeks. Follow-up was 55 ± 31 months.
Results: Percutaneous extraction was attempted in 493 pts. Complete removal of the implanted material was performed surgically in 68 pts. Lead extraction was incomplete in 41 cases and failed or not performed in 49 pts. A new device was implanted in 360 pts, with transvenous leads in 176 and epicardic leads in 184 pts. The mean time of endocardial in-hospitalization reimplantation was 14.3 days (1-35 days). Multivariate analysis has found single risk factors of recurrences. No extraction was strongly associated with recurrences. The recurrences rates were 0, 2.6% and 36.3% after surgical extraction, percutaneous extraction and medical treatment respectively and 1.6%, 2.6% and 22.2% after complete, incomplete and unsuccesfull extraction respectively. No recurrences occurred after surgical extraction, epicardic reimplantation. We did not find a difference of recurrence rate in case of endocardial reimplantation before and after 15 days post-extraction but analysis have shown that a higher recurrence rate could exist when reimplantation occurred before 4 days post- extraction and at the opposite a very low recurrence rate when reimplantation occurred more than 30 days post-extraction..
Conclusion: Recurrences were strongly associated with no or incomplete material removal. A higher recurrence rate could exist when reimplantation occurred before 4 days post-extraction and at the opposite a very low recurrence rate when reimplantation occurred more than 30 days post-extraction.
- © 2011 by American Heart Association, Inc.