Device-Related Infective Endocarditis in Cardiac Resynchronization Therapy Recipients – Single Center Registry With Over 2500 Person-Years Follow Up

• Published in: International journal of cardiology Vol. 227; pp. 18 - 24
• Main Authors: Jędrzejczyk-Patej, Ewa, M.D, Mazurek, Michał, M.D, Kowalski, Oskar, M.D, Sokal, Adam, M.D, Kozieł, Monika, M.D, Adamczyk, Karolina, M.D, Przybylska-Siedlecka, Katarzyna, M.D, Morawski, Stanisław, M.D, Liberska, Agnieszka, M.D, Szulik, Mariola, M.D, Podolecki, Tomasz, M.D, Kowalczyk, Jacek, M.D, Kalarus, Zbigniew, M.D, Lenarczyk, Radosław, M.D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.01.2017
• Subjects: Aged; Cardiac resynchronization therapy; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy - mortality; Cardiac Resynchronization Therapy - trends; Cardiac Resynchronization Therapy Devices - adverse effects; Cardiac Resynchronization Therapy Devices - microbiology; Cardiac Resynchronization Therapy Devices - trends; Cardiovascular; Device-related infective endocarditis; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - etiology; Endocarditis, Bacterial - mortality; Equipment Contamination; Female; Follow-Up Studies; Heart failure; Humans; Incidence; Male; Middle Aged; Registries; Risk factors; Survival Rate - trends; heart failure; risk factors; device-related infective endocarditis; cardiac resynchronization therapy; incidence; Heart failure; Cardiac resynchronization therapy; Device-related infective endocarditis; Risk factors; Incidence
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.11.029

Aim To assess incidence, predisposing factors and outcomes of cardiac device-related infective endocarditis (CDRIE) in patients undergoing cardiac resynchronization therapy (CRT). Methods and Results High-volume, single-center cardiology database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 13.7% and 15.5% up-grades from pacemaker and implantable cardioverter-defibrillator [ICD], respectively). During the median follow-up (FU) of 1207 days (range:256–2664) overall 38 CDRIE (4.97%) cases were identified (incidence: 15/1000 person-years). Multivariate Cox regression model, incorporating significant baseline differences as covariates (model 1), demonstrated that both up-grade from ICD to CRT and higher baseline NYHA class were independently associated with increased risk of CDRIE (adjusted HR 4.29, 95%CI 1.93–9.57; and HR 2.43, 95%CI 1.32–4.49, respectively). In the second model (including all differences with P < 0.2) up-grade from ICD (HR 4.36, 95%CI 1.96–9.69), higher NYHA class (HR 2.04, 95%CI 1.11–3.75), hypertrophic cardiomyopathy (HR 5.85, 95% CI 1.46–23.52), lower baseline hemoglobin level (HR 0.68, 95%CI 0.50–0.94) and chronic obstructive pulmonary disease (HR 2.46, 95%CI 1.05–5.77) were all independently associated with higher risk of CDRIE. All-cause mortality in patients with CDRIE was significantly higher than in subjects without infective complications (68.4% vs. 33.7%, P < 0.001), and 50% of patients with CDRIE died during index hospitalization. Conclusions The prevalence of CDRIE in CRT recipients is almost 5% within 3.5 years post implantation. Up-grade from ICD and high baseline NYHA class flag up patients at high-risk of CDRIE. CRT-related infective complications are associated with very poor prognosis.