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. 2023 Aug 2;25(9):euad208.
doi: 10.1093/europace/euad208.

Cardiac implantable electronic device implantation and device-related infection

Vivek Modi  1 , Kashyap Shah  1 , Bruce Ferraro  1 , Leyla Gasimli-Gamache  1 , Sudip Nanda  1 , Steven Stevens  1 , Jamshid Shirani  1
Affiliations

Cardiac implantable electronic device implantation and device-related infection

Vivek Modi et al. Europace. .

Abstract

Aims: Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device-related infections (DRI) remain a significant complication of CIED and are associated with major adverse outcomes. We aimed to assess the trend in CIED implantations, and the burden and morbidity associated with DRI.

Methods and results: The 2011-2018 National Inpatient Sample database was searched for admissions for CIED implantation and DRI. A total of 1 604 173 admissions for CIED implantations and 71 007 (4.4%) admissions for DRI were reported. There was no significant change in annual admission rates for DRI (3.96-4.59%, P value for trend = 0.98). Those with DRI were more likely to be male (69.3 vs. 57%, P < 0.001) and have a Charlson comorbidity index score ≥3 (46.6 vs. 36.8%, P < 0.001). The prevalence of congestive heart failure (CHF) increased in those admitted with DRI over the observation period. Pulmonary embolism, deep vein thrombosis, and post-procedural hematoma were the most common complications in those with DRI (4.1, 3.6, and 2.90%, respectively). Annual in-hospital mortality for those with DRI ranged from 3.9 to 5.8% (mean 4.4%, P value for trend = 0.07). Multivariate analysis identified CHF [odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.35-2.07], end-stage renal disease (OR = 1.90; 95% CI = 1.46-2.48), coagulopathy (OR = 2.94; 95% CI = 2.40-3.61), and malnutrition (OR = 2.50; 95% CI = 1.99-3.15) as the predictors of in-hospital mortality for patients admitted with DRI.

Conclusion: Device-related infection is relatively common and continues to be associated with high morbidity and mortality. The prevalence of DRI has not changed significantly despite technical and technological advances in cardiac devices and their implantation.

Keywords: Cardiac implantable electronic device; Cost; Device-related infection; Length of stay; Mortality; Prognosis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
CHF, congestive heart failure; CIED, cardiac implantable electronic device; DRI, device-related infections; ESRD, end-stage renal disease; NIS, national inpatient sample.
Figure 1
Figure 1
Trends of comorbidities and Charlson index in patients with device-related infection (DRI) from 2011 to 2018. Trends for coronary artery disease (P = 0.94) and end-stage renal disease (P = 0.88) were statistically insignificant while all other comorbidities showed significant interval increase (P < 0.001 for all others). CAD, coronary artery disease; Charlson, Charlson comorbidity index; CHF, congestive heart failure; DM, diabetes mellitus; ESRD, end-stage renal disease.
Figure 2
Figure 2
Trend of cardiac implantable electronic device (CIED) implantation from 2011 to 2018 by device type. All trends were statistically significant at P < 0.001 level. CRT, cardiac resynchronization therapy; ICD, implantable cardioverter defibrillator; PPM, permanent pacemaker.
Figure 3
Figure 3
Trend of device-related infection (DRI) between 2011 and 2018 (P trend = 0.98).
Figure 4
Figure 4
Top panel: the mean hospital length of stay of patients with device-related infection (DRI) increased from ∼12 days in 2011 to ∼14 days in 2018 (P < 0.001). Middle panel: the mean inflation-adjusted total hospital charges increased by 36% during this time (P < 0.001). Bottom panel: in-hospital mortality increased from 3.9% in 2011 to 4.6% in 2018 with a peak in 2015 (P = 0.07).
See this image and copyright information in PMC

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