TY - JOUR
T1 - Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades
T2 - A Population-Based Study
AU - Dai, Mingyan
AU - Cai, C.
AU - Vaibhav, Vaidya
AU - Sohail, M. Rizwan
AU - Hayes, David L.
AU - Hodge, David O.
AU - Tian, Ying
AU - Asirvatham, Roshini
AU - Cochuyt, Jordan J.
AU - Huang, Congxin
AU - Friedman, Paul A.
AU - Cha, Yong Mei
N1 - Funding Information:
This work was funded by the Department of Cardiovascular Diseases, Mayo Clinic. Dr. Sohail has been a consultant for Medtronic and Aziyo Biologics. Dr. Friedman has been a consultant for Medtronic and Boston Scientific; and has received research support from St. Jude Medical and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019
PY - 2019/9
Y1 - 2019/9
N2 - Objectives: This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study. Background: Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs. Methods: We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation. Results: The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection. Conclusions: The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
AB - Objectives: This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study. Background: Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs. Methods: We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation. Results: The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection. Conclusions: The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
KW - cardiovascular implantable electronic devices infection
KW - population-based study
KW - trends
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U2 - 10.1016/j.jacep.2019.06.016
DO - 10.1016/j.jacep.2019.06.016
M3 - Article
C2 - 31537337
AN - SCOPUS:85071878131
SN - 2405-5018
VL - 5
SP - 1071
EP - 1080
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 9
ER -