Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) infections still constitute asignificant challenge. Theknowledge of risk factors for CIED infections is crucial for preventing infections and reducing mortality rates. OBJECTIVES Theaim of this study was to assess therisk factors and long-term survival of patients with CIED infections. PATIENTS AND METHODS We analyzed theclinical data of 1837 patients (including 750 [40.9%] patients with CIED infections), who underwent transvenous lead extraction ata single institution between 2006 and2015. We compared theclinical 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 Thedevelopment 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 thenumber of previous procedures. Thefactors that determined ILRIE included chronic kidney disease (CKD), ICD/CRT-D, lead loops, and intracardiac lead abrasion. Chronic anticoagulation and antiplatelet treatment protected against thedevelopment of infection. Long-term survival was significantly related to age, heart failure, diabetes mellitus, CKD, malignancy, and chronic atrial fibrillation. CONCLUSIONS Thedevelopment of all types of CIED infection was associated mainly with procedure-related factors, while long-‑term mortality was dependent on clinical factors. Thedissimilarity of factors affecting thedevelopment of IPI and ILRIE confirms that there are 2 variants of CIED infection. Theprotective effects of chronic anticoagulation and antiplatelet treatment should prompt us to consider such therapy in theprevention of CIED infection.
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