Abstract 17130: Systemic Infection From Non-Pocket Source is Associated With Worse Outcomes Compared With Pocket Source

Abstract

Introduction: Systemic infection can occur in patients with cardiac devices due to spread from pocket infection or a non-pocket source. Data comparing outcomes of systemic infection from pocket vs. non-pocket source are lacking Hypothesis: We hypothesized that systemic infection from non-pocket source is associated with worse outcomes compared with pocket source. Methods: We collected data for all patients with systemic infection, who underwent transvenous lead extraction (TLE) between April 2004 and June 2015. Patients were divided into 2 groups- systemic infection from pocket source and non-pocket source. Results: Out of total 700 TLE procedures for infectious indication, 407 patients (58.1%) had evidence of systemic infection. Out of these, 167 (41%) had systemic infection from pocket source and 240 (59%) had systemic infection from non-pocket sources. Patients with pocket source were older (69.7± 13.4 vs. 66.3± 13.5 years, p value 0.011), less likely to be on dialysis (8.4% vs. 23.8%), and more likely to have CRT system (39.5% vs. 23.8%). Pocket source group had higher incidence of coagulase negative staphylococcus infection (32.3% vs. 19.6%) and presence of abandoned leads (32.3% vs. 10.8%).Patients with non-pocket source were more likely to have endocarditis (81.7% vs. 55.1%). There was no difference in TLE procedure outcomes, complications during hospital stay, and 30-day mortality (10.3% vs. 13.7%, p value 0.330). However, 1-year mortality was significantly higher in patients with non-pocket source (41% vs. 28.1%, p value 0.019). Kaplan-Meier survival curves showed worse survival in non-pocket source group up to 6 years of follow up. Conclusions: In conclusion, there is no difference in procedural or short-term outcomes between patients with systemic infection from pocket vs. non-pocket source after TLE. However, patients with systemic infection from non-pocket source are more likely to have endocarditis and have worse long-term mortality.