scholarly journals Prevention of Cardiac Implantable Electronic Device–Related Infection in Patients With Cancer: The Role of a Comprehensive Prophylactic Bundle Approach That Includes the Antimicrobial Mesh

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Melissa Khalil ◽  
Kaveh Karimzad ◽  
Jean-Bernard Durand ◽  
Alexandre E Malek ◽  
Issam I Raad ◽  
...  
Keyword(s):  
Electronic Device ◽  
Hematologic Malignancy ◽  
Polymyxin B ◽  
Cardiac Resynchronization ◽  
Solid Cancer ◽  
Mechanical Complication ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Surgical Interventions

Abstract Background Oncological patients have several additional risk factors for developing a cardiac implantable electronic device (CIED)–related infection. Therefore, we evaluated the clinical impact of our comprehensive bundle approach that includes the novel minocycline and rifampin antimicrobial mesh (TYRX) for the prevention of CIED infections in patients living with cancer. Methods We retrospectively reviewed all consecutive patients who had a CIED placement at our institution during 2012–2017 who received preoperative vancomycin, intraoperative pocket irrigation with bacitracin and polymyxin B, plus TYRX antimicrobial mesh, followed by postoperative oral minocycline. Results A total of 154 patients had a CIED, with 97 permanent pacemakers (PPMs), 23 implantable cardioverter defibrillators (ICDs), and 34 cardiac resynchronization therapy (CRT) devices. An underlying solid cancer was present in 62% of patients, while 38% had a hematologic malignancy. Apart from a higher proportion of surgical interventions in the PPM group than in the ICD and CRT groups (P = .007), no other oncologic variables were statistically significantly different between groups. Despite an extensive median follow-up period (interquartile range) of 21.9 (6.7–33.8) months, 16 patients (10%) had a mechanical complication, while only 2 patients (1.3%) developed a CIED infection, requiring the device to be explanted. Conclusions Our comprehensive prophylactic bundle approach using TYRX antimicrobial mesh in an oncologic population at high risk for infections was revealed upon extensive follow-up to be both safe and effective in maintaining the rate of CIED infection at 1.3%, well within published averages in the broader population of CIED recipients.

scholarly journals Cardiac implantable electronic device related chest pain: A focused review

2021 ◽  
Vol 4 (1) ◽  
pp. 50-54
Author(s):  
Jahanzeb Malik ◽  
Kashif Khan
Keyword(s):  
Chest Pain ◽  
Cardiac Resynchronization Therapy ◽  
Electronic Device ◽  
Cardiac Resynchronization ◽  
Common Symptom ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Resynchronization Therapy ◽  
Cardiac Resynchronization Therapy Devices ◽  
Cardioverter Defibrillators

More than 600,000 patients undergo cardiac implantable electronic device (CIED) implantation in a year, which comprise of pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices (CRT). The most common symptom experienced after a CIED implantation is chest pain. In this review, we describe CIED implantation and associated complications causing chest pain.

Variations in cardiac implantable electronic device surveillance and ancillary testing in the paediatric and congenital heart disease population: an international multi-centre survey from the Paediatric and Congenital Electrophysiology Society

2021 ◽  
pp. 1-5
Author(s):  
Melissa M. Olen ◽  
Brynn E. Dechert ◽  
Anne Foster ◽  
Ronald J. Kanter ◽  
Michael J. Silka ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Electronic Device ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Clinical Practices ◽  
Device Implantation

Abstract Background: Expert guidance from scientific societies and regulatory agencies recommend a framework of principles for frequency of in-person evaluations and remote monitoring for patients with cardiac implantable electronic devices. However, there are limited data regarding adherence to recommendations among paediatric electrophysiologists, and there are no data regarding cardiac implantable electronic device-related ancillary testing. Methods: To assess current clinical practices for cardiac implantable electronic device in-person evaluation, remote monitoring, and cardiac implantable electronic device-related ancillary testing, the Paediatric and Congenital Electrophysiology Society members were surveyed. The main outcome measures were variations in frequency of in person evaluation, frequency of remote monitoring, and cardiac implantable electronic device-related ancillary testing. Results: All respondents performed in-person evaluation at least once a year, but <50% of respondents performed an in-person evaluation within 2 weeks of cardiac implantable electronic device implantation. Remote monitoring was performed every 3 months for pacemakers and implantable cardioverter defibrillators by 71 and 75% respondents, respectively. Follow-up echocardiography was performed every 2–3 years by 53% respondents for patients with >50% ventricular pacing. Majority of respondents (75%) did not perform either an exercise stress test or ambulatory Holter monitoring or chest X-ray (65%) after cardiac implantable electronic device implantation. Conclusion: This survey identified significant practice variations in cardiac implantable electronic device in- person evaluation, remote monitoring, and ancillary testing practices among paediatric electrophysiologists. Cardiac implantable electronic device management may be optimised by development of a paediatric-specific guidelines for follow-up and ancillary testing.

scholarly journals New Insights into Predictors of Cardiac Implantable Electronic Device Infection

2018 ◽  
Vol 45 (3) ◽  
pp. 128-135 ◽  
Author(s):  
Hossein Sadeghi ◽  
Abolfath Alizadehdiz ◽  
Amirfarjam Fazelifar ◽  
Zahra Emkanjoo ◽  
Majid Haghjoo
Keyword(s):  
De Novo ◽  
Electronic Device ◽  
Cardiac Resynchronization ◽  
Cardiac Implantable Electronic Device ◽  
Revision Procedure ◽  
Device Implantation ◽  
Postoperative Hematoma ◽  
Device Infection ◽  
Low Body Mass Index

Infection is an important complication of cardiac implantable electronic device procedures. To further study the factors associated with infection, we retrospectively reviewed the records of 3,205 consecutive patients who had undergone de novo or revision cardiac electronic device implantation at our institution from March 2011 through March 2015. We recorded all infections and specified whether they were related to the characteristics of the patient, device, or procedure. To identify predictors of infection, we performed multivariate analysis. Device infections were identified in 85 patients (2.7%), at a mean follow-up time of 27 ± 11 months. The main predictors of device infection were use of an implantable cardioverter-defibrillator or a cardiac resynchronization therapy defibrillator device (odds ratio [OR]=16; 95% CI, 4.14–61.85; P=0.0001), stage 3 chronic kidney disease (OR=9.41; 95% CI, 1.77–50.04; P=0.009), a revision procedure (OR=8.8; 95% CI, 3.37–23.2; P=0.0001), or postoperative hematoma (OR=6.9; 95% CI, 1.58–30.2; P=0.01). We also identified 2 novel predictors of infection: a low body mass index of &lt;20 kg/m2 (OR=1.03; 95% CI, 1.01–1.06; P=0.005), and use of povidone-iodine rather than chlorhexidine-alcohol for topical antisepsis (OR=4.4; 95% CI, 2.01–9.4; P=0.03). We conclude that comorbidities, device characteristics, procedure types, and postoperative noninfective complications all increase the risk of device infection after a cardiac implantable electronic device procedure.

scholarly journals Subclinical cardiac perforation by cardiac implantable electronic device leads detected by cardiac computed tomography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yeong-Min Lim ◽  
Jae-Sun Uhm ◽  
Min Kim ◽  
In-Soo Kim ◽  
Moo-Nyun Jin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Ct ◽  
Electronic Device ◽  
Cardiac Computed Tomography ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Cardiac Perforation ◽  
Mr Conditional ◽  
Septal Pacing

Abstract Background The relationship between the characteristics of cardiac implantable electronic device (CIED) leads and subclinical cardiac perforations remains unclear. This study aimed to evaluate the incidence of subclinical cardiac perforation among various CIED leads using cardiac computed tomography (CT). Methods A total of 271 consecutive patients with 463 CIED leads, who underwent cardiac CT after CIED implantation, were included in this retrospective observational study. Cardiac CT images were reviewed by one radiologist and two cardiologists. Subclinical perforation was defined as traversal of the lead tip past the outer myocardial layer without symptoms and signs related to cardiac perforation. We compared the subclinical cardiac perforation rates of the available lead types. Results A total of 219, 49, and 3 patients had pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy, respectively. The total subclinical cardiac perforation rate was 5.6%. Subclinical cardiac perforation by screw-in ventricular leads was significantly more frequent than that caused by tined ventricular leads (13.3% vs 3.3%, respectively, p = 0.002). There were no significant differences in the incidence of cardiac perforation between atrial and ventricular leads, screw-in and tined atrial leads, pacing and defibrillator ventricular leads, nor between magnetic resonance (MR)-conditional and MR-unsafe screw-in ventricular leads. Screw-in ventricular leads were significantly associated with subclinical cardiac perforation [odds ratio, 4.554; 95% confidence interval, 1.587–13.065, p = 0.005]. There was no case subclinical cardiac perforation by septal ventricular leads. Conclusions Subclinical cardiac perforation by screw-in ventricular leads is not rare. Septal pacing may be helpful in avoiding cardiac perforation.

Canadian Registry of Electronic Device Outcomes: remote monitoring outcomes in the Abbott battery performance alert—a multicentre cohort

EP Europace ◽  
2021 ◽  
Author(s):  
Sharath Kumar ◽  
Jason Davis ◽  
Bernard Thibault ◽  
Iqwal Mangat ◽  
Benoit Coutu ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Primary Outcome ◽  
Electronic Device ◽  
Electronic Devices ◽  
Cardiac Resynchronization ◽  
Device Performance ◽  
Cardiac Implantable Electronic Devices ◽  
All Cause Mortality ◽  
Multicentre Cohort

Abstract Aims Cardiac implantable electronic devices with device advisories have the potential of device malfunction. Remote monitoring (RM) of devices has been suggested to allow the identification of abnormal device performance and permit early intervention. We sought to describe the outcomes of patients with and without RM in devices subject to the Abbott Premature Battery Depletion (PBD) advisory with data from a Canadian registry. Methods and results Patients with an Abbott device subject to the PBD advisory from nine implantable cardioverter defibrillator (ICD) implanting centres in Canada were included in the registry. The use of RM was identified from baseline and follow-up data in the registry. The primary outcome was detection of PBD and all-cause mortality. A total of 2666 patients were identified with a device subject to the advisory. In all, 1687 patients (63.2%) had RM at baseline. There were 487 deaths during follow-up. At a mean follow-up of 5.7 ± 0.7 years, mortality was higher in those without a remote monitor compared with RM at baseline (24.7% vs. 14.5%; P &lt; 0.001). Pre-mature battery depletion was identified in 36 patients (2.1%) with RM vs. 7 (0.7%) without RM (P = 0.004). Time to battery replacement was significantly reduced in patients on RM (median 5 vs. 13 days, P = 0.001). Conclusion The use of RM in patients with ICD and cardiac resynchronization therapy under advisory improved detection of PBD, time to device replacement, and was associated with a reduction in all-cause mortality. The factors influencing the association with mortality are unknown and deserve further study.

scholarly journals No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

2022 ◽  
Author(s):  
M. Feijen ◽  
A. D. Egorova ◽  
E. T. van der Velde ◽  
M. J. Schalij ◽  
S. L. M. A. Beeres
Keyword(s):  
Excess Mortality ◽  
Electronic Device ◽  
Cardiac Implantable Electronic Device ◽  
Strict Adherence ◽  
Chronic Heart Disease ◽  
Vulnerable Patients ◽  
All Cause Mortality ◽  
Complicated Course ◽  
Baseline Characteristics

AbstractIn the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.

scholarly journals European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections—endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

EP Europace ◽  
2019 ◽  
Vol 22 (4) ◽  
pp. 515-549 ◽  
Author(s):  
Carina Blomström-Lundqvist ◽  
Vassil Traykov ◽  
Paola Anna Erba ◽  
Haran Burri ◽  
Jens Cosedis Nielsen ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Latin American ◽  
Electronic Device ◽  
Heart Rhythm ◽  
Asia Pacific ◽  
Cardiac Resynchronization ◽  
Cardiac Implantable Electronic Device ◽  
International Consensus ◽  
Consensus Document ◽  
Cardiac Resynchronization Therapy Devices

Abstract Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.

scholarly journals Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey

EP Europace ◽  
2012 ◽  
Vol 14 (3) ◽  
pp. 423-425 ◽  
Author(s):  
G. Marinskis ◽  
L. van Erven ◽  
M. G. Bongiorni ◽  
G. Y. H. Lip ◽  
L. Pison ◽  
...  
Keyword(s):  
Electronic Device ◽  
Heart Rhythm ◽  
Cardiac Implantable Electronic Device
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