Antibiotic envelope is associated with reduction in cardiac implantable electronic devices infections especially for high-power device-Systematic review and meta-analysis.

Raymond Pranata,Yoga Yuniadi,Alexander Edo Tondas,Rachel Vania

doi:10.1002/joa3.12270

Abstract

BackgroundInfections after cardiac implantable electronic device (CIED) placement are associated with significant morbidity and mortality. The incidence of CIED is increasing overtime despite the optimal use of antimicrobial agents. This systematic review and meta‐analysis will address the latest evidence on the use of AE to mitigate the risk of CIED infection, and which subset of patients will they benefit the most.MethodsWe performed a comprehensive search on topics that assesses antibiotic envelope and implantable cardiac electronic device up until August 2019.ResultsThere were a total of 32,329 subjects from six studies. Antibiotic envelope was associated with a lower risk of major infection with OR 0.42 [0.19, 0.97], P = .04; I2: 58% and HR 0.52 [0.32, 0.85], P = .009; I2: 80%. Upon sensitivity analysis by removing a study, the OR became 0.40 [0.27, 0.59], P < .001; I2: 46%. Subgroup analysis for 12 months’ infection was OR 0.65 [0.43, 0.99], P = .04; I2: 49%. Meta‐analysis of propensity‐matched cohort showed a reduced risk of infection with AE (OR of 0.14 [0.05, 0.41], P < .001; I2:0%). Mortality was similar in both AE and control groups. Antibiotic envelope reduced the incidence of infection in patients receiving high‐power device (OR 0.44 [0.27, 0.73], P = .001; I2:0%) but not low‐power device.ConclusionAntibiotic envelope (TYRX) was found to be safe and effective in reducing the risk of major infections in high‐risk patients receiving CIED implantation, especially in those receiving high‐power CIED.

Highlights

Cardiac implantable electronic device (CIED) is commonly used worldwide by cardiac electrophysiologists to treat various cardiovascular problems including cardiomyopathies, rhythm disorders, and prevention of sudden cardiac deaths.[1,2,3] Infections after cardiac implantable electronic device (CIED) placement are associated with significant morbidity and mortality.[4,5,6] The incidence of CIED is increasing overtime despite the optimal use of antimicrobial agents.[7,8,9]Antibiotic envelope (AE) (TYRX Absorbable Antibacterial Envelope) was developed to mitigate the risk of infection.[10]
Infections after CIED placement are associated with significant morbidity and mortality.[4,5,6]
We explore the effectiveness of AE on patients receiving high-power device (CRT-D and implantable cardioverter-defibrillator (ICD)) and lowpower device (CRT-P and pacemaker) placement

Summary

Introduction

Cardiac implantable electronic device (CIED) is commonly used worldwide by cardiac electrophysiologists to treat various cardiovascular problems including cardiomyopathies, rhythm disorders, and prevention of sudden cardiac deaths.[1,2,3] Infections after CIED placement are associated with significant morbidity and mortality.[4,5,6] The incidence of CIED is increasing overtime despite the optimal use of antimicrobial agents.[7,8,9]Antibiotic envelope (AE) (TYRX Absorbable Antibacterial Envelope) was developed to mitigate the risk of infection.[10]. Subgroup analysis showed that AE reduced the incidence of infection in patients receiving high-power device (OR 0.44 [0.27, 0.73], P = .001; I2:0%, P = .37) [Figure 4A].

Results

Conclusion