Among 2,500 ICD recipients, the overall rate of device-related infection was low at 0.8% within 24 months, with primary electrical disorders and secondary prevention indications as significant predictors.
RCT (n=2,500)
Defibrillation testing or not
Yes
What are the rate, time course, and predictors of ICD infections in patients receiving an implantable cardioverter defibrillator?
The risk of ICD-related infection is low (0.8% at 24 months) in high-volume centers, but strategies to reduce wound hematoma and reinterventions could further lower this risk.
BackgroundThe number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors.MethodsThe Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics.ResultsWithin 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection.ConclusionsThis cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection.
Philippon et al. (Mon,) conducted a rct in ICD recipients (n=2,500). Defibrillation testing vs. No defibrillation testing was evaluated on ICD infection requiring device removal and/or intravenous antibiotics. Among 2,500 ICD recipients, the overall rate of device-related infection was low at 0.8% within 24 months, with primary electrical disorders and secondary prevention indications as significant predictors.