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Variability in clinical features of early versus late cardiovascular implantable electronic device pocket infections
Mariko Welch1, Daniel Z Uslan, Arnold J Greenspon
1Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
Background:
Cardiovascular implantable electronic device (CIED) pocket infections are often related to recent CIED placement or manipulation, but these infections are not well characterized. The clinical presentation of CIED pocket infection, based on temporal onset related to last CIED procedure, deserves further study.
Methods:
The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled subjects with CIED infection. Subjects were stratified into those whose infection occurred <12 months (early) or ≥ 12 months (late) since their last CIED-related procedure.
Results:
There were 132 subjects in the early group and 106 in the late group. There were more females (P = 0.009) and anticoagulation use (P = 0.039) in the early group. Subjects with early infections were more likely to have had a generator change or lead addition as their last procedure (P = 0.03) and had more prior CIED procedures (P = 0.023). Early infections were more likely to present with pocket erythema (P < 0.001), swelling (P < 0.001), and pain (P = 0.007). Late infections were more likely to have pocket erosion (P = 0.005) and valvular vegetations (P = 0.009). In bacteremic subjects, early infections were more likely healthcare-associated (P < 0.001). In-hospital and 6-month mortality were equivalent.
Conclusion:
A total of 45% of patients with CIED pocket infection presented >12 months following their last CIED-related procedure. Patients with early infection were more likely to be female, on anticoagulation, and present with localized inflammation, whereas those with late infection were more likely to have CIED erosion or valvular endocarditis.
Insights
Cardiovascular implantable electronic device (CIED) infections present differently based on timing. Early infections show localized inflammation, while late infections may involve erosion or valvular endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Cardiovascular implantable electronic device (CIED) pocket infections are a known complication, but their clinical presentation based on timing relative to procedures is not well-characterized.
- Understanding these differences is crucial for timely diagnosis and management of CIED infections.
Purpose of the Study:
- To characterize the clinical presentation of CIED pocket infections based on their temporal onset after the last CIED-related procedure.
- To identify distinct features of early (<12 months) versus late (≥12 months) CIED infections.
Main Methods:
- Prospective enrollment of subjects with CIED infection into the MEDIC (Multicenter Electrophysiologic Device Infection Cohort) study.
- Stratification of subjects into early (<12 months) and late (≥12 months) infection groups based on the time since their last CIED-related procedure.
Main Results:
- A total of 238 subjects were analyzed (132 early, 106 late).
- Early infections were more common in females and those on anticoagulation, often following generator changes or lead additions, presenting with erythema, swelling, and pain.
- Late infections were more frequently associated with pocket erosion and valvular vegetations.
Conclusions:
- 45% of CIED pocket infections occurred more than 12 months after the last procedure.
- Early CIED infections typically present with localized inflammatory signs, while late infections are more indicative of device erosion or endocarditis.
- Mortality rates were similar for both early and late infection groups in the short term.
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