Risk of Cardiovascular Implantable Electronic Device Infection in Patients With Cardiac Sarcoidosis

BACKGROUND: Immunosuppressive therapy plays a key role in managing cardiac sarcoidosis (CS). The decision to implant a cardiovascular implantable electronic device (CIED) is frequently made alongside the initiation of immunosuppression. However, it remains unclear whether being on immunosuppressive therapy at the time of CIED implantation increases the risk of infection. As both interventions can be lifesaving, it is important to determine whether adjustments to immunosuppressive regimens are necessary to mitigate infection risk. OBJECTIVE: To assess the correlation between CIED-related infections and Immunosuppression in patients with cardiac sarcoidosis at a tertiary care center. METHODS: We conducted a retrospective review of patients with biopsy-confirmed CS who received a CIED and were followed at Johns Hopkins Hospital. Data collected included CIED type, number of procedures and leads, use of an antibiotic envelope, and immunosuppressive therapy at the time of each procedure. The primary outcome was the occurrence of a CIED pocket infection or bloodstream infection (BSI). RESULTS: A total of 175 patients were included, with a mean age of 60.1 years (SD ± 11.4); 63.4% were male, 53.1% were White, and 41.1% Black. The majority received implantable cardioverter-defibrillators (ICDs) (162/175, 92.5%). The average follow-up duration was 8.6 years. At the time of implantation, 70 patients were on immunosuppressive therapy: 36 on corticosteroids alone, 8 on steroid-sparing agents, and 26 on combination therapy. During the follow-up period, 12 patients developed BSIs. Of these, 5 were on immunosuppression at the time of implantation. All infections were treated with antibiotics; 9 patients underwent device extraction. There was no significant difference in infection rates between those on immunosuppression at implantation and those who were not (5/70 vs. 7/105; p = 0.90). There was no significant difference in management between both groups. Two patients also developed pocket infections, both following multiple prior CIED procedures. One case involved a S. aureus infection 4 years after a revision performed while on immunosuppression. The other involved a Propionibacterium acnes infection 4 months after a revision performed off immunosuppression. CONCLUSION: In this cohort of patients with cardiac sarcoidosis undergoing CIED implantation, immunosuppressive therapy at the time of implantation was not associated with an increased risk of device-related infection.