Author + information
- Received March 1, 2019
- Revision received June 13, 2019
- Accepted June 27, 2019
- Published online August 28, 2019.
- Mingyan Dai, MDa,b,
- Cheng Cai, MDb,c,
- Vaidya Vaibhav, MBBSb,
- M. Rizwan Sohail, MDb,d,
- David L. Hayes, MDb,
- David O. Hodge, MSe,
- Ying Tian, MD, PhDb,f,
- Roshini Asirvathamb,
- Jordan J. Cochuyte,
- Congxin Huang, MD, PhDa,
- Paul A. Friedman, MDb and
- Yong-Mei Cha, MDb,∗ ()
- aDepartment of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
- bDepartment of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- cDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- dDepartment of Internal Medicine, Division of Infectious Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- eDepartment of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- fDepartment of Cardiology, Beijing Chaoyang Hospital, Beijing, China
- ↵∗Address for correspondence:
Dr. Cha, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives This study assessed trends in the incidence of cardiovascular implantable electronic device (CIED) infection in the last 3 decades using a population-based records linkage study.
Background Infection remains an important issue associated with increased implantation rate and dwell time of CIEDs.
Methods We identified a cohort of all adults with CIEDs who resided in Olmsted County, Minnesota, from 1988 to 2015, using the medical linkage system of the Rochester Epidemiology Project. Standardized criteria were used to identify all CIED infection cases. The cumulative rate of CIED infection was estimated using the Kaplan-Meier method, and the trends of CIED infection incidence were calculated with person-years of follow-up after device implantation.
Results The cumulative probabilities of overall CIED infection were 6.2% (95% confidence interval [CI]: 4.0% to 8.4%) at 15 years and 11.7% (95% CI: 6.8% to 17.3%) at 25 years of follow-up. The incidence of CIED infection every 7 years from 1988 to 2015 was 1.3, 5.7, 4.1, and 4.7 per 1,000-person years, respectively. The 15-year cumulative probabilities of CIED infection after the initial, second, and third procedures were 2.6% (95% CI: 1.4% to 3.8%), 2.7% (95% CI: 1.2% to 4.2%), and 24.1% (95% CI: 3.8% to 44.4%), respectively. Generator changes (hazard ratio [HR]: 3.91; 95% CI: 1.47 to 10.37; p = 0.006) and upgrades (HR: 3.08; 95% CI: 1.24 to 7.62; p = 0.02) were significantly associated with infection.
Conclusions The incidence of CIED infection had a trend of increasing in the past 2 decades. Contemporary implantable cardioverter-defibrillator and cardiac resynchronization therapies and repeated manipulation of device pockets introduced a greater risk of CIED infection.
This work was funded by the Department of Cardiovascular Diseases, Mayo Clinic. Dr. Sohail has been a consultant for Medtronic and Aziyo Biologics. Dr. Friedman has been a consultant for Medtronic and Boston Scientific; and has received research support from St. Jude Medical and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 March 1, 2019.
- Revision received June 13, 2019.
- Accepted June 27, 2019.
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