Infectious complications in patients with cardiac implantable electronic devices: risk factors, prevention, and prognosis

INTRODUCTION Cardiac implantable electronic device (CIED) infections still constitute a significant challenge. The knowledge of risk factors for CIED infections is crucial for preventing infections and reducing mortality rates.
OBJECTIVES The aim of this study was to assess the risk factors and long­‑term survival of patients with CIED infections.
PATIENTS AND METHODS We analyzed the clinical data of 1837 patients (including 750 [40.9%] patients with CIED infections), who underwent transvenous lead extraction at a single institution between 2006 and 2015. We compared the clinical and procedure­‑related factors for all types of CIED infections: isolated pocket infection (IPI), isolated lead­‑related infective endocarditis (ILRIE), and lead­‑related infective endocarditis with coexisting pocket infection (LRIE + PI). We also analyzed long­‑term survival rates.
RESULTS The development of IPI and LRIE + PI depended mainly on age, male sex, number of leads, presence of implantable cardioverter–defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT­‑D), and the number of previous procedures. The factors that determined ILRIE included chronic kidney disease (CKD), ICD/CRT­‑D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against the development of infection. Long­‑term survival was significantly related to age, heart failure, diabetes mellitus, CKD, malignancy, and chronic atrial fibrillation.
CONCLUSIONS The development of all types of CIED infection was associated mainly with procedure­‑related factors, while long­‑term mortality was dependent on clinical factors. The dissimilarity of factors affecting the development of IPI and ILRIE confirms that there are 2 variants of CIED infection. The protective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in the prevention of CIED infection.