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Infection of implantable cardioverter defibrillator systems: a preventable complication?
D M Shahian1, W A Williamson, D Martin
1Department of Thoracic and Cardiovascular Surgery, Lahey Clinic, Burlington, Massachusetts 01805.
Insights
Primary implantable cardioverter defibrillator (ICD) procedures had low in-hospital mortality (1.2%) and low rates of early (0.61%) and late (0.61%) system infection. Complications included hematomas and generator erosion.
Area of Science:
- Cardiology
- Medical Devices
- Infectious Disease
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
- Understanding complication rates associated with primary ICD implantation is essential for patient safety and device management.
Purpose of the Study:
- To evaluate the early complication rates, including mortality and infection, following primary transvenous implantable cardioverter defibrillator (ICD) implantation.
- To report on the incidence of generator pocket hematomas and device erosion in patients undergoing ICD implantation.
Main Methods:
- A consecutive series of 164 patients undergoing primary ICD implantation were retrospectively analyzed.
- Data collected included in-hospital mortality, early and late system infections, generator pocket hematomas, and device erosion.
Main Results:
- In-hospital mortality was 1.2% (2/164 patients).
- Early system infection occurred in 0.61% (1/164), requiring device explantation.
- Late infection (0.61%) and generator pocket hematomas (1.8%) were observed, with most hematomas managed conservatively. Generator erosion occurred in one patient.
Conclusions:
- Primary ICD implantation demonstrates a low risk of mortality and systemic infection.
- Generator pocket hematomas and erosion are potential complications that require careful management.
- Guidelines for preventing ICD system infections are presented to minimize adverse events.
Abstract:
In a consecutive series of 164 patients undergoing primary implantation of an implantable cardioverter defibrillator (ICD), two patients died in the hospital (1.2%) and early system infection developed in one patient requiring explantation of the device (0.61%). Late infection developed in one additional patient (0.61%) 7 months after transvenous ICD implantation, and was thought to be due to a recent intravascular catheterization. Symptomatic generator pocket hematomas developed in three patients, two of which were treated by simple evacuation and one with temporary generator explanation and subsequent reimplantation of the unit in a new pocket. No infection developed in these three patients during follow-up. Generator erosion without obvious system infection developed in a fourth patient. Guidelines for the prevention of infection in ICD systems are presented.