Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections. A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort)

Thomas A. Boyle, Daniel Z. Uslan, Jordan M. Prutkin, Arnold J. Greenspon, Larry M. Baddour, Stephan B. Danik, Jose M. Tolosana, Katherine Le, Jose M. Miro, James E. Peacock, Muhammad R. Sohail, Holenarasipur R. Vikram, Roger G. Carrillo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. Background: Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. Results: Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions: The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2017

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Equipment and Supplies
Infection
Lasers
Leukocytosis
Signs and Symptoms
Registries
Comorbidity
Skin

Keywords

  • Abandoned leads
  • Endocarditis
  • Lead capping
  • Lead extraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections. A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort). / Boyle, Thomas A.; Uslan, Daniel Z.; Prutkin, Jordan M.; Greenspon, Arnold J.; Baddour, Larry M.; Danik, Stephan B.; Tolosana, Jose M.; Le, Katherine; Miro, Jose M.; Peacock, James E.; Sohail, Muhammad R.; Vikram, Holenarasipur R.; Carrillo, Roger G.

In: JACC: Clinical Electrophysiology, 01.01.2017.

Research output: Contribution to journalArticle

Boyle, Thomas A. ; Uslan, Daniel Z. ; Prutkin, Jordan M. ; Greenspon, Arnold J. ; Baddour, Larry M. ; Danik, Stephan B. ; Tolosana, Jose M. ; Le, Katherine ; Miro, Jose M. ; Peacock, James E. ; Sohail, Muhammad R. ; Vikram, Holenarasipur R. ; Carrillo, Roger G. / Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections. A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort). In: JACC: Clinical Electrophysiology. 2017.
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abstract = "Objectives: This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. Background: Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. Results: Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions: The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.",
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T1 - Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections. A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort)

AU - Boyle, Thomas A.

AU - Uslan, Daniel Z.

AU - Prutkin, Jordan M.

AU - Greenspon, Arnold J.

AU - Baddour, Larry M.

AU - Danik, Stephan B.

AU - Tolosana, Jose M.

AU - Le, Katherine

AU - Miro, Jose M.

AU - Peacock, James E.

AU - Sohail, Muhammad R.

AU - Vikram, Holenarasipur R.

AU - Carrillo, Roger G.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. Background: Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. Results: Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions: The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.

AB - Objectives: This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. Background: Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods: The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. Results: Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions: The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.

KW - Abandoned leads

KW - Endocarditis

KW - Lead capping

KW - Lead extraction

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