Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

Verda Arshad; Larry M. Baddour; Brian D. Lahr; Sarwat Khalil; Wajeeha Tariq; Khawaja Muhammad Talha; Yong Mei Cha; Daniel C. DeSimone; M. Rizwan Sohail

doi:10.1111/pace.14297

Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

Verda Arshad, Larry M. Baddour, Brian D. Lahr, Sarwat Khalil, Wajeeha Tariq, Khawaja Muhammad Talha, Yong Mei Cha, Daniel C. DeSimone, M. Rizwan Sohail

Medicine - Infectious Disease and International Medicine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue.

METHODS: We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations.

RESULTS: A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re-implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079).

CONCLUSION: Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.

Original language	English (US)
Pages (from-to)	1303-1311
Number of pages	9
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	44
Issue number	8
DOIs	https://doi.org/10.1111/pace.14297
State	Published - Aug 2021

Bibliographical note

Funding Information:
Study data were collected using REDCap database software (NIH grant support ‐ UL1 TR000135)

Funding Information:
The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years. The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years.

Publisher Copyright:
© 2021 Wiley Periodicals LLC

Keywords

cardiovascular implantable electronic device
implantable cardiac defibrillator
infection
infective endocarditis
permanent pacemaker
re-implantation

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10.1111/pace.14297

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Arshad, V., Baddour, L. M., Lahr, B. D., Khalil, S., Tariq, W., Talha, K. M., Cha, Y. M., DeSimone, D. C., & Sohail, M. R. (2021). Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis. PACE - Pacing and Clinical Electrophysiology, 44(8), 1303-1311. https://doi.org/10.1111/pace.14297

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title = "Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis",

abstract = "BACKGROUND: Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue.METHODS: We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations.RESULTS: A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re-implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079).CONCLUSION: Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.",

keywords = "cardiovascular implantable electronic device, implantable cardiac defibrillator, infection, infective endocarditis, permanent pacemaker, re-implantation",

author = "Verda Arshad and Baddour, {Larry M.} and Lahr, {Brian D.} and Sarwat Khalil and Wajeeha Tariq and Talha, {Khawaja Muhammad} and Cha, {Yong Mei} and DeSimone, {Daniel C.} and Sohail, {M. Rizwan}",

note = "Funding Information: Study data were collected using REDCap database software (NIH grant support ‐ UL1 TR000135) Funding Information: The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years. The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years. Publisher Copyright: {\textcopyright} 2021 Wiley Periodicals LLC",

year = "2021",

month = aug,

doi = "10.1111/pace.14297",

language = "English (US)",

volume = "44",

pages = "1303--1311",

journal = "PACE - Pacing and Clinical Electrophysiology",

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TY - JOUR

T1 - Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

AU - Arshad, Verda

AU - Baddour, Larry M.

AU - Lahr, Brian D.

AU - Khalil, Sarwat

AU - Tariq, Wajeeha

AU - Talha, Khawaja Muhammad

AU - Cha, Yong Mei

AU - DeSimone, Daniel C.

AU - Sohail, M. Rizwan

N1 - Funding Information: Study data were collected using REDCap database software (NIH grant support ‐ UL1 TR000135) Funding Information: The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years. The authors are extremely grateful for the philanthropic support provided by a gift from Eva and Gene Lane (L.M.B.), which was paramount in our work to advance the science of cardiovascular infections, which has been an ongoing focus of investigation at Mayo Clinic for over 60 years. Publisher Copyright: © 2021 Wiley Periodicals LLC

PY - 2021/8

Y1 - 2021/8

N2 - BACKGROUND: Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue.METHODS: We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations.RESULTS: A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re-implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079).CONCLUSION: Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.

AB - BACKGROUND: Optimal timing of cardiovascular implantable electronic device (CIED) re-implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED-IE). The current work seeks to clarify this issue.METHODS: We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED-IE from January 1, 1991 to February 1, 2016. CIED-IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re-implantation and the location of vegetations.RESULTS: A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re-implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12-month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079).CONCLUSION: Our findings suggest that the recommended 14-day delay between CIED extraction and re-implantation in CIED-IE patients is associated with a survival benefit, but longer length of hospital stay following re-implantation.

KW - cardiovascular implantable electronic device

KW - implantable cardiac defibrillator

KW - infection

KW - infective endocarditis

KW - permanent pacemaker

KW - re-implantation

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AN - SCOPUS:85111393102

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Impact of delayed device re-implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

Abstract

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