Author + information
- Received July 10, 2017
- Revision received September 14, 2017
- Accepted September 21, 2017
- Published online February 19, 2018.
- Thomas A. Boyle, BSa,∗ (, )
- Daniel Z. Uslan, MD, MBAb,
- Jordan M. Prutkin, MD, MHSc,
- Arnold J. Greenspon, MDd,
- Larry M. Baddour, MDe,
- Stephan B. Danik, MDf,
- Jose M. Tolosana, MD, PhDg,
- Katherine Le, MDe,
- Jose M. Miro, MD, PhDg,
- James E. Peacock, MDh,
- Muhammad R. Sohail, MDe,
- Holenarasipur R. Vikram, MDi,
- Roger G. Carrillo, MDa,∗ (, )
- for the MEDIC Investigators
- aDepartment of Surgery, Division of Cardiothoracic Surgery, University of Miami, Miami, Florida
- bDepartment of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- cDepartment of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
- dDepartment of Medicine, Division of Cardiology, Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- eDepartment of Medicine, Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
- fDepartment of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- gCardiology and Infectious Disease Services, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- hDepartment of Medicine, Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
- iDepartment of Medicine, Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona
- ↵∗Address for correspondence:
Dr. Thomas A. Boyle OR Dr. Roger G. Carrillo, Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Hospital, 1295 NW 14th Street, Suite H, Miami, Florida 33125.
Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections.
Background Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate.
Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none.
Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010).
Conclusions The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
This study was funded in part by a grant from the American Heart Association. Data from the Hospital Clinic of Barcelona, Spain, were supported in part by a grant from the Ministerio de Sanidad y Consumo, the Instituto de Salud Carlos III, and Spanish Network for Research in Infectious Diseases grant REIPI RD06/0008, Madrid, Spain. Dr. Greenspon has received honoraria from or is consultant for Medtronic, Boston Scientific, and St. Jude Medical. Dr. Baddour has received royalty payments from UpToDate, Inc., for authorship duties. Dr. Peacock owns common stock in Pfizer. Dr. Sohail has received a research grant from Medtronic, Inc.; and is a consultant for Medtronic, Inc. and Boston Scientific. Dr. Carrillo has received research funding from or is a consultant for Spectranetics, Abbott, Medtronic, St. Jude Medical, Sorin group, and Sensormatic. Dr. Miró has received research funding from Institut d’Investigaciones Biomédiques August Pi i Sunyer; and has received research funding from or is a consultant for Angelini, AbbVie, Bristol-Myers Squibb, Cubist, Genentech, Medtronic, Merck, Novartis, Gilead Sciences, and ViiV healthcare. Dr. Tolosana is a consultant for Boston Scientific, Medtronic, St. Jude Medical, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 10, 2017.
- Revision received September 14, 2017.
- Accepted September 21, 2017.
- 2018 American College of Cardiology Foundation
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