Author + information
- Received May 3, 2013
- Revision received May 28, 2013
- Accepted May 30, 2013
- Published online December 1, 2013.
- John Rickard, MD∗∗ (, )
- Khaldoun Tarakji, MD†,
- Alan Cheng, MD∗,
- David Spragg, MD∗,
- Daniel J. Cantillon, MD†,
- David O. Martin, MD, MPH†,
- Bryan Baranowski, MD†,
- Steven M. Gordon, MD‡,
- W.H. Wilson Tang, MD†,
- Mohammed Kanj, MD†,
- Oussama Wazni, MD† and
- Bruce L. Wilkoff, MD†
- ∗Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
- †Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ‡Division of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. John Rickard, Johns Hopkins University, Cardiology, 4940 Eastern Avenue, Baltimore, Maryland 21224.
Objectives This study sought to compare outcomes in patients with biventricular device infections who undergo successful treatment including extraction and reimplantation to patients with biventricular devices never known to become infected.
Background Infection of a cardiac implantable electronic device (CIED) is associated with substantial morbidity and mortality. Survival in patients with cardiac resynchronization therapy (CRT) device infections undergoing full system extraction is unknown.
Methods We extracted data on all patients undergoing extraction of a biventricular pacing device for an infectious indication at the Cleveland Clinic between February 16, 2000, and June 30, 2011. Survival of patients who presented with a CRT device infection, extraction, and successful reimplantation was compared to that of a large cohort of consecutive patients undergoing initial CRT implantation without a known history of subsequent device-related infection. In addition, long-term outcomes were compared between patients who were extracted and deemed to be cured with and without successful biventricular device reimplantation.
Results In all, 151 patients underwent biventricular device extraction for infection, of whom 81 were successfully reimplanted. The noninfected cohort consisted of 879 patients. In a multivariate Cox regression model controlling for sex, a history of ischemic cardiomyopathy, creatinine, hemoglobin, beta-blocker use, angiotensin-converting enzyme inhibitor use, and diuretic use, no significant association between subsequent infection with reimplantation and all-cause mortality was noted (p = 0.21). There was a trend toward worse outcomes for patients extracted, deemed cured, and not reimplanted compared to patients with successful CRT reimplantation.
Conclusions Patients with a biventricular device infection who are successfully extracted, treated with antibiotics, and reimplanted with a biventricular device have outcomes similar to those of patients with biventricular devices not known to have become infected.
Dr. Rickard has given a funded talk for St. Jude Medical. Dr. Cheng has received honoraria from Biotronik, Boston Scientific, Medtronic, and St. Jude Medical. Dr. Spragg has received honoraria from Sorin Medical. Dr. Wilkoff has received physician advisory from Medtronic, St. Jude Medical, and Spectranetics (<$10,000.00). All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2013.
- Revision received May 28, 2013.
- Accepted May 30, 2013.
- American College of Cardiology Foundation