Repeated procedures at the generator pocket are a determinant of implantable cardioverter‐defibrillator infection

Background Rates of cardiac‐device infections have increased in recent years, but the current incidence and risk factors for infection in patients with implantable cardioverter‐defibrillators (ICDs) are not well known. Hypothesis The increasing number of ICD infections is related to accumulated pock...

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Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2017-10, Vol.40 (10), p.892-898
Main Authors: Arana‐Rueda, Eduardo, Pedrote, Alonso, Frutos‐López, Manuel, Acosta, Juan, Jauregui, Beatriz, García‐Riesco, Lorena, Arce‐León, Álvaro, Gómez‐Pulido, Federico, Sánchez‐Brotons, Juan A., Gutiérrez‐Carretero, Encarnación, de Alarcón‐González, Arístides
Format: Article
Language:English
Subjects:
Adult
Aged
Clinical Investigations
Confidence intervals
Defibrillation–ICD
Defibrillators, Implantable - adverse effects
Electric Countershock - adverse effects
Electric Countershock - instrumentation
Electric Countershock - mortality
Female
Humans
Incidence
Infection Complication
Infections
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Noninvasive Risk Assessment Tests
Patients
Proportional Hazards Models
Prospective Studies
Prosthesis-Related Infections - diagnosis
Prosthesis-Related Infections - epidemiology
Prosthesis-Related Infections - microbiology
Prosthesis-Related Infections - mortality
Registries
Risk Assessment
Risk Factors
Spain - epidemiology
Time Factors
Treatment Outcome
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Summary:Background Rates of cardiac‐device infections have increased in recent years, but the current incidence and risk factors for infection in patients with implantable cardioverter‐defibrillators (ICDs) are not well known. Hypothesis The increasing number of ICD infections is related to accumulated pocket manipulations over time. Methods This single‐center, prospective study included patients that underwent ICD implantation from 2008 to 2015. The endpoint was time to infection. Multivariate analysis was performed to identify independent risk factors related to infection. Results The study included a total of 570 patients, of whom 419 (73.5%) underwent a first implantation. Mean age was 59 ± 14 years, and 80% were male. During a median follow‐up of 36 months (interquartile range, 18–61 months; 1887 patient‐years), infection was identified in 26 patients (4.56%), an incidence of 14.9 × 1000 patient‐years. Median time to infection was 9.7 months (interquartile range, 1.35–23.4 months), and 38.5% were late infections (beyond 12 months of follow‐up). In patients with replacement implants, the incidence was 3‐fold higher than in first implantations (27.7 vs 9.1 × 1000 patient‐years; P = 0.002). Cox regression identified 2 independent predictors of ICD infection: cumulative number of interventions at the generator pocket (hazard ratio: 1.92, 95% confidence interval: 1.42‐2.6, P < 0.001) and pocket hematoma (hazard ratio: 7.0, 95% confidence interval: 2.7‐17.9, P < 0.0001). Conclusions The incidence of infection in ICD patients is greater than previously reported, largely due to late infections. Each new cumulative intervention at the same generator pocket nearly doubles the risk of infection.
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.22743