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. 2021 Jun;44(6):739-747.
doi: 10.1002/clc.23620. Epub 2021 May 25.

Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital

Bozena Ostrowska  1   2 , Spyridon Gkiouzepas  2   3 , Siri Kurland  4 , Carina Blomström-Lundqvist  1   2
Affiliations

Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital

Bozena Ostrowska et al. Clin Cardiol. 2021 Jun.

Abstract

Background: The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI).

Hypothesis: The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry.

Methods: Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases.

Results: A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow-up, giving a prevalence of 7% (incidence of 29/1000 person-years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead-related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5-fold underreporting.

Conclusions: The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications.

Keywords: cardiac resynchronization; complications; device; endocarditis; infection; pacemaker registry; pocket.

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Conflict of interest statement

Bozena Ostrowska, Spyridon Gkiouzepas, and Siri Kurland have nothing to disclose. Carina Blomstrom‐Lundqvist reports personal fees from Bayer, Medtronic, CathPrint, Octopus, Sanofi Aventis, Boston Sci, and Merck Sharp and Dohme outside the submitted work.

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