Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades: A Population-Based Study

Mingyan Dai, C. Cai, Vaidya Vaibhav, M. Rizwan Sohail, David L. Hayes, David O. Hodge, Ying Tian, Roshini Asirvatham, Jordan J. Cochuyt, Congxin Huang, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1071-1080
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2019

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Equipment and Supplies
Infection
Population
Confidence Intervals
Incidence
Cardiac Resynchronization Therapy
Implantable Defibrillators
Epidemiology

Keywords

  • cardiovascular implantable electronic devices infection
  • population-based study
  • trends

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades : A Population-Based Study. / Dai, Mingyan; Cai, C.; Vaibhav, Vaidya; Sohail, M. Rizwan; Hayes, David L.; Hodge, David O.; Tian, Ying; Asirvatham, Roshini; Cochuyt, Jordan J.; Huang, Congxin; Friedman, Paul Andrew; Cha, Yong-Mei.

In: JACC: Clinical Electrophysiology, Vol. 5, No. 9, 01.09.2019, p. 1071-1080.

Research output: Contribution to journalArticle

Dai, M, Cai, C, Vaibhav, V, Sohail, MR, Hayes, DL, Hodge, DO, Tian, Y, Asirvatham, R, Cochuyt, JJ, Huang, C, Friedman, PA & Cha, Y-M 2019, 'Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades: A Population-Based Study', JACC: Clinical Electrophysiology, vol. 5, no. 9, pp. 1071-1080. https://doi.org/10.1016/j.jacep.2019.06.016
Dai, Mingyan ; Cai, C. ; Vaibhav, Vaidya ; Sohail, M. Rizwan ; Hayes, David L. ; Hodge, David O. ; Tian, Ying ; Asirvatham, Roshini ; Cochuyt, Jordan J. ; Huang, Congxin ; Friedman, Paul Andrew ; Cha, Yong-Mei. / Trends of Cardiovascular Implantable Electronic Device Infection in 3 Decades : A Population-Based Study. In: JACC: Clinical Electrophysiology. 2019 ; Vol. 5, No. 9. pp. 1071-1080.
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abstract = "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.",
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AU - Dai, Mingyan

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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 Andrew

AU - Cha, Yong-Mei

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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.

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