Clinical profile and outcomes among patients with cardiac implantable electronic device presenting as isolated pocket infection, pocket-related infective endocarditis or lead-related infective endocarditis.

Abstract

Aims: The clinical spectrum of cardiac implantable electronic device (CIED) infections includes isolated pocket infection (IPI), pocket infection complicated by infective endocarditis (PIRIE), and lead-related infective endocarditis (LRIE). The aim of this study was to assess the risk factors, clinical course and outcomes in patients with CIED infections and to demonstrate differences between PIRIE and LRIE.

Methods and results: The retrospective analysis of data from 3847 patients undergoing transvenous lead extraction (TLE) for non-infectious (2640; 68.62%) and infectious (1207; 31.38%) indications including 361 (29.91%) IPI, 472 (39.11%) PIRIE and 374 (30.99%) LRIE showed some differences in risk factors, clinical course and outcomes between the subgroups. Unlike PIRIE, diabetes [HR=1.488; 95%CI(1.178÷1.879), P<0.001] and lead abrasion [HR=2.117 95%CI(1.665÷2.691), P<0.001] increased the risk of LRIE. The risk of pocket infection spread was greater with S. Aureus infection [HR=1.596; 95%CI(1.202-2.120), p<0.001). Compared to LRIE, patients with PIRIE had lower levels of inflammatory markers and lower prevalence of vegetations. Mortality in PIRIE compared to LRIE patients was lower (53.18% vs 62.30%; p<0.001) and comparable to IPI (50.69%; p=0.162) at long-term [median 1828 (815÷3139) days] follow-up.

Conclusion: CIED infections share common risk factors, however, diabetes and intracardiac lead abrasion predispose to LRIE, whereas multiple leads and Staphylococcus aureus in pocket culture are risk factors for pocket infection spread. Compared to LRIE, the clinical course of PIRIE was milder and short- and long-term mortalities were lower, but comparable to IPI after more than one year. This may be an argument in favour of categorization into primary LRIE and secondary endocarditis, i.e. PIRIE.