Henrikson, Charles A.

Introduction: Implantable cardioverter-defibrillators (ICDs) reduce morbidity and mortality in appropriately selected patients, but device-related infections are associated with significant mortality that can mitigate this benefit. Women are at higher risk for adverse events during ICD procedure admissions, but there are limited data on the mortality associated ICD infection in women. Objective: To compare the clinical characteristics and mortality rate of men and women who have an infection associated with ICD procedure. Methods: Retrospective cohort study of 64,903 Medicare fee-for-service patients admitted for ICD generator implantation, replacement, or revision from January 1, 2007 to December 31, 2007. Primary outcome measures were unadjusted and risk-adjusted longer-term mortality associated with ICD infection. Results: There were a total of 1,855 (2.89%) admissions with an ICD infection. Longer-term mortality (death during admission quarter and subsequent 4 quarters) was significantly higher with ICD infection than without (28.4% vs. 16.7%, P<0.001). While longer-term mortality without ICD infection was significantly lower for women (hazard ratio=0.89 [95%CI 0.85-0.93]), longer-term mortality with ICD infection was significantly higher for women, compared to men (hazard ratio=1.20 [95%CI 1.03-1.41]. Multivariate regression analysis adjusting for age, gender, race/ethnicity and 28 comorbidities demonstrated a significant interaction between gender and ICD infection associated short and, and longer-term mortality. The risk-adjusted longer-term mortality with ICD infection was significantly higher for women compared to men (hazard ratio = 1.25 [95% CI 1.02-1.53]). Conclusions: Women have significantly higher rate of death, compared to men, following infection associated with ICD procedures. Further studies to determine the underlying causes of this disparity are warranted.

Introduction: Patients with congenital heart disease (CHD) frequently require implantable cardiac devices. Device infection or malfunction may necessitate lead extraction. Extraction may be challenging due to long lead dwell times, anatomic abnormalities, and prior cardiac surgery. Little is known about extraction outcomes in the CHD population. Methods and Results: This retrospective study included 41 CHD patients and 82 age and gender matched controls that underwent lead extractions at two centers between 2001-2014. Only patients with leads older than 12 months were included. There were 79 leads in CHD patients and 150 in controls. Patients with CHD had a mean age of 39±17 years at extraction and on average their leads had been implanted for 81±84 months, this was not significantly different from the control group. Eighty eight percent of CHD patients had 1 or more cardiac surgeries as compared to only 22% of controls (p<0.001). The number of abandoned leads was also significantly different with 16 abandoned leads in the CHD group and 3 in controls (p<0.001). There was no statistically significant difference in extraction techniques between the groups. Complete extraction was achieved in 94% of patients in both groups. There were no CHD group complications. Control group complications included 3 SVC lacerations requiring sternotomy (one was fatal), and 1 ventricular perforations with tamponade requiring sternotomy. None of these patients had a history of cardiac surgery. The average age of leads in patients with a complication was 15.3 years which was older than the mean lead age seen in the CHD and control populations which was 6.75 and 4.6 years respectively. Conclusions: Lead extraction can be safely performed in patients with CHD. Despite anatomic abnormalities and previous cardiac surgery, the outcome of lead extraction in patients with CHD is comparable to controls. Prior cardiac surgery may lower the risk for extraction complications.

BackgroundDevice infection is associated with increased mortality in patients receiving cardiovascular implantable electronic device (CIED) therapy. However, long‐term mortality associated with CIED infections has not been systematically analyzed in larger studies. This study sought to determine the long‐term mortality associated with CIED infection in a large cohort of Medicare beneficiaries.MethodsWe used a retrospective study design to analyze 3‐year mortality in 200,219 Medicare fee‐for‐service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007. Multivariate analysis adjusting for age, sex, race, and 28 comorbidities was performed to determine the relative risk (RR) of death in the 12 quarters following CIED infection.ResultsPatients with CIED infection, compared to device recipients without infection, had increased mortality that persisted for at least 3 years after the admission quarter for all device types: pacemakers (PMs: 53.8% vs 33%; P < 0.001), implantable cardioverter defibrillator (ICD: 47.7% vs 31.6%; P < 0.001), and cardiac resynchronization therapy‐defibrillator (CRT‐D: 50.8% vs 36.5%; P < 0.001). After adjusting for patient demographics and comorbidities, significantly increased RR of death following CIED infection persisted for at least 3 years following PM infection, and for at least 2 years with single‐ and dual‐chamber ICD infection.ConclusionsCIED recipients who develop device infection have increased, device‐dependent, long‐term mortality even after successful treatment of infection. The etiology of this persistent increased risk of death associated with CIED infection is unknown and merits further investigation.