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Circulation: Arrhythmia and Electrophysiology
After device infection, strategies for whether to reimplant hardware and the timing of this decision vary. This observational study analyzes the MEDIC database, a prospective multicenter registry of cardiac implantable electronic device infections in patients from 10 institutions in the United States, Spain, and Germany. The results show repeat infection rates were low for patients who underwent new device implantation in the first few days to weeks after extraction of infected hardware. Rates of recurrent infection were high in those who did not undergo extraction. While the observational nature of the study is a limitation, it suggests that device extraction is critical in clearing device-related infection and in appropriate patients, device reimplantation may carry a low risk for recurrent infection.
Reimplantation and Repeat Infection After Cardiac Implantable Electronic Device Infections
Experience From the MEDIC (Multicenter Electrophysiological Device Infection Cohort) Database
Thomas A. Boyle, BS
Daniel Z. Uslan, MD, MBA
Jordan M. Prutkin, MD, MHS
Arnold J. Greenspon, MD
Larry M. Baddour, MD
Stephan B. Danik, MD
Jose M. Tolosana, MD, PhD
Katherine Le, MD
Jose M. Miro, MD, PhD
James Peacock, MD
Muhammad R. Sohail, MD
Holenarasipur R. Vikram, MD
Roger G. Carrillo, MD
Correspondence to: Thomas A. Boyle, BS, Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Hospital, 1295 NW 14th Street, Suite H, Miami, FL 33125 or Roger G. Carrillo MD FHRS, Department of Cardiothoracic Surgery, University of Miami Hospital, 1295 NW 14th Street, Suite H, Miami, FL 33125. E-mail firstname.lastname@example.org or email@example.com
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 Electrophysiological 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 …