Rates and Risk-Factors of Post Implantation Infection in Cardiac Implantable Electronic Devices

Background/Hypothesis: Cardiac implantable electronic devices (CIED) include permanent pacemakers (PPM), implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy (CRT). Both ICDs and dual chamber PPMs are two-lead systems; whereas, CRT is a three-lead system. Indications for CIEDs include arrythmia, risk of sudden cardiac death and AV block. From 1993 to 2003, over 4 million CIEDs were implanted. With the upward trend in the rate of CIED implantations, the post-operative infection burden has increased concurrently. Device related infections are a serious complication of CIED implants. They are associated with a significant increase in the rate of mortality as well as a significant increase in financial burden. We hypothesize two-lead systems will have significantly lower rate of infection than three-lead devices Methods: This study will be a retrospective review of patient charts who are hospitalized in the Parkview Health medical system in Fort Wayne, Indiana over a three-year period. All patients who have received a CIED during that time frame will be included in the study. Patients will be categorized by specific implant type and recorded as developing post-operation infection or not. Demographic and health status data will also be collected and analyzed for correlation with the development of device related infection. Results: Our results will compare the device related infection rate for two-lead versus three lead systems, as well as the infection rate for each type of CIED. We also expect to find results which support a correlation between specific patient demographics and patient health factors. Conclusion and Impact: The results of this study will serve as a guide for identifying high risk procedures and patients. The objective is to provide providers with guidelines for the use of post-operative prophylaxis in order to reduce the incidence of CIED-related infection.

Download Full-text

The New Challenge for Heart Endocarditis: From Conventional Prosthesis to New Devices and Platforms for the Treatment of Structural Heart Disease

BioMed Research International ◽

10.1155/2021/7302165 ◽

2021 ◽

Vol 2021 ◽

pp. 1-17

Author(s):

Francesco Nappi ◽

Adelaide Iervolino ◽

Sanjeet Singh Avtaar Singh

Keyword(s):

Inflammatory Responses ◽

Clinical Success ◽

Electronic Devices ◽

Structural Heart Disease ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Noticeable Increase ◽

Cardiac Implantable Electronic Devices ◽

Cardiac Resynchronization Therapy Devices ◽

Transcatheter Heart Valve

Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use “low fouling coats” with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.

Download Full-text

Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000111 ◽

2015 ◽

Vol 26 (4) ◽

pp. 356-363

Author(s):

Melanie T. Gura

Keyword(s):

Terminal Illness ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Life Saving ◽

Cardioverter Defibrillators ◽

Proactive Communication

Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations.

Download Full-text

Local complications in patients with cardiac implantable devices

In a good rythm ◽

10.5604/01.3001.0013.1684 ◽

2019 ◽

Vol 1 (50) ◽

pp. 14-18

Author(s):

Karolina Adamczyk ◽

Ewa Jędrzejczyk-Patej

Keyword(s):

Electronic Devices ◽

Implantable Devices ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Systemic Complications ◽

Local Complications ◽

Cardiac Implantable Electronic Devices ◽

Cardioverter Defibrillators ◽

Life Prolongation ◽

Pocket Hematoma

Cardiac implantable electronic devices (CIEDs) such as pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), both with or without cardiac resynchronization therapy (CRT), became one of the fundamental therapies in present-day electrocardiology. The CIED patients population is increasing year by year due to a growing number of CIED implantations annually and a life prolongation among patients with CIEDs through better pharmacology combined with the proper electrotherapy and patient care. Invasive procedures related to CIED such as an implantation, a replacement or an up-grade of any kind electrotherapy device involves the risk of complications. Pocket hematoma or infection, which are local complications, should be recognized rapidly and treat properly in order to avoid more threatening systemic complications.

Download Full-text

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

EP Europace ◽

10.1093/europace/euab025 ◽

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 < 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.

Download Full-text

Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa249 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6

Author(s):

Fozia Zahir Ahmed ◽

Carol Crosbie ◽

Matthew Kahn ◽

Manish Motwani

Keyword(s):

Heart Failure ◽

High Risk ◽

Electronic Devices ◽

Management Strategies ◽

Phone Call ◽

Cardiac Resynchronization ◽

Physiological Data ◽

Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

Download Full-text

Results of remote follow-up and monitoring in young patients with cardiac implantable electronic devices

Cardiology in the Young ◽

10.1017/s1047951114002613 ◽

2015 ◽

Vol 26 (1) ◽

pp. 53-60 ◽

Cited By ~ 2

Author(s):

Massimo S. Silvetti ◽

Fabio A. Saputo ◽

Rosalinda Palmieri ◽

Silvia Placidi ◽

Lorenzo Santucci ◽

...

Keyword(s):

Remote Monitoring ◽

Heart Defects ◽

Electronic Devices ◽

Young Patients ◽

Implantable Cardioverter Defibrillators ◽

Wireless Devices ◽

Cardiac Implantable Electronic Devices ◽

System Inclusion ◽

To Receive

AbstractBackgroundRemote monitoring is increasingly used in the follow-up of patients with cardiac implantable electronic devices. Data on paediatric populations are still lacking. The aim of our study was to follow-up young patients both in-hospital and remotely to enhance device surveillance.MethodsThis is an observational registry collecting data on consecutive patients followed-up with the CareLink system. Inclusion criteria were a Medtronic device implanted and patient’s willingness to receive CareLink. Patients were stratified according to age and presence of congenital/structural heart defects (CHD).ResultsA total of 221 patients with a device – 200 pacemakers, 19 implantable cardioverter defibrillators, and two loop recorders – were enrolled (median age of 17 years, range 1–40); 58% of patients were younger than 18 years of age and 73% had CHD. During a follow-up of 12 months (range 4–18), 1361 transmissions (8.9% unscheduled) were reviewed by technicians. Time for review was 6±2 minutes (mean±standard deviation). Missed transmissions were 10.1%. Events were documented in 45% of transmissions, with 2.7% yellow alerts and 0.6% red alerts sent by wireless devices. No significant differences were found in transmission results according to age or presence of CHD. Physicians reviewed 6.3% of transmissions, 29 patients were contacted by phone, and 12 patients underwent unscheduled in-hospital visits. The event recognition with remote monitoring occurred 76 days (range 16–150) earlier than the next scheduled in-office follow-up.ConclusionsRemote follow-up/monitoring with the CareLink system is useful to enhance device surveillance in young patients. The majority of events were not clinically relevant, and the remaining led to timely management of problems.

Download Full-text

Tatalaksana Perioperatif pada Pasien dengan Cardiac Implantable Electronic Devices (Cieds) atau Alat Elektronik Kardiovaskular Implan (Aleka)

JAI (Jurnal Anestesiologi Indonesia) ◽

10.14710/jai.v11i2.24714 ◽

2019 ◽

Vol 11 (2) ◽

pp. 81

Author(s):

Cindy Elfira Boom ◽

Ornella Widyapuspita

Keyword(s):

Cardiac Resynchronization Therapy ◽

Electronic Devices ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardiac Implantable Electronic Devices

Jumlah pasien pengguna cardiac implantable electronic devices (CIEDs) atau alat elektronik kardiovaskular implan (ALEKA) hingga saat ini makin bertambah setiap tahunnya di penjuru dunia, namun masih banyak ahli anestesi yang belum nyaman dalam mengelola pelayanan perioperatif pada pasien-pasien tersebut dikarenakan kurangnya pengetahuan dan pengalaman pemrograman alat untuk menatalaksana pasien. Alat elektronik kardiovaskular implan merupakan sebuah istilah yang mencakup penggunaan alat pacu jantung untuk bradiaritmia dan implantable cardioverter defibrilator (ICD)/defibrilator kadioverter implan (DKI) untuk takiaritmia, serta cardiac resynchronization therapy (CRT)/ terapi resinkronisasi jantung (TRJ) untuk disfungsi diastolik dengan hambatan konduksi. Hingga saat ini, tercatat setidaknya lebih dari 250.000 pasien dewasa maupun anak menjalani pemasangan alat pacu jantung tiap tahunnya, oleh karena itu, penting bagi seorang dokter anestesi untuk memahami dan mampu membuat perencanaan perioperatif dengan tim multidisiplin agar dapat menurunkan morbiditas dan mortalitas pasien. Tinjauan pustaka ini dibuat untuk memberikan info seputar ALEKA dengan berfokus pada manajemen perioperatif pasien dengan ALEKA, serta algoritma tatalaksana yang dapat diimplementasikan dalam praktik sehari-hari.

Download Full-text

Home Monitoring for Cardiovascular Implantable Electronic Devices

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000110 ◽

2015 ◽

Vol 26 (4) ◽

pp. 343-355 ◽

Cited By ~ 1

Author(s):

Robin A. Leahy ◽

Elizabeth E. Davenport

Keyword(s):

Electronic Devices ◽

Home Monitoring ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

Cardiovascular Implantable Electronic Devices ◽

Technological Advances ◽

Cardiac Resynchronization Therapy Devices ◽

Cardioverter Defibrillators

Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians’ ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers.

Download Full-text

Late Breaking Clinical Trials: what do they change in everyday practice in patients who are or will be implanted with cardiac electrotherapy device?

In a good rythm ◽

10.5604/01.3001.0014.0496 ◽

2020 ◽

Vol 4 (53) ◽

pp. 4-7

Author(s):

Ewa Jędrzejczyk-Patej ◽

Michał Mazurek

Keyword(s):

Clinical Trials ◽

Electronic Devices ◽

Everyday Practice ◽

Cardiac Resynchronization ◽

Cardiac Pacemakers ◽

Cardiac Implantable Electronic Devices ◽

Cardioverter Defibrillators

Patients with cardiac implantable electronic devices (CIEDs) constitute a considerable population. Issues related to CIEDs both in the field of cardiac pacemakers, cardioverter-defibrillators, and cardiac resynchronization are still intensively studied. This article presents the results of selected, relevant studies on CIEDs announced or published in 2019.

Download Full-text

JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices

Journal of Radiation Research ◽

10.1093/jrr/rraa102 ◽

2020 ◽

Vol 62 (1) ◽

pp. 172-184

Author(s):

Toshiki Ohno ◽

Toshinori Soejima ◽

Yukio Sekiguchi ◽

Takayuki Hashimoto ◽

Izumi Koike ◽

...

Keyword(s):

Japanese Society ◽

Electronic Devices ◽

Implantable Cardioverter Defibrillators ◽

Implantable Defibrillators ◽

English Version ◽

Cardiac Implantable Electronic Devices ◽

New Findings ◽

Multidisciplinary Working ◽

Medical Physicists ◽

Cardioverter Defibrillators

ABSTRACT This publication is an English version of the Japanese Society for Radiation Oncology (JASTRO) and The Japanese Circulation Society official guidelines for patients with cardiac implantable electronic devices (CIEDs). Several radiotherapy-associated malfunctions have been reported for CIEDs such as pacemakers and implantable cardioverter-defibrillators. Accordingly, guidelines for radiotherapy in patients with CIEDs have been issued by other countries and societies. In August 2010, JASTRO published the ‘Radiotherapy Guidelines for Patients with Pacemakers and Implantable Defibrillators’ (hereafter referred to as the former guidelines). Given new findings in this decade, a multidisciplinary working group of radiation oncologists, medical physicists, radiation therapists and cardiologists jointly reviewed and revised the former guidelines.

Download Full-text