Low incidence rate of infections associated with cardiac implantable electronic device procedures in a large real-world patient cohort

Funding Acknowledgements Type of funding sources: None. Background The incidence of death and infections in patients implanted with cardiac implantable electronic devices (CIEDs) are not fully known yet (1,2). Purpose To describe the incidence of death and device’s infection and its potential predictors in a contemporary cohort of CIED patients. Methods All consecutive patients implanted with a CIED at our tertiary institution were prospectively enrolled. Follow-up was performed every six months and clinical events recorded by expert electrophysiologists. For the purpose of the present analysis, we considered patients with a potential follow-up of at least 24 months. Results Between 01/09/2018 and 01/09/2020, a total of 838 patients were enrolled (34.6% female; age 77 [70-84]; PADIT score 2 [2-4]). Pacemaker (PM) and implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) were implanted in 569 (68%) and 269 (32%) patients respectively. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, 212 (25.5%) patients died and 5 (0.6%) had a CIED infection. Four out of five patients required CIED extraction, while 1 patient antibiotics only. At multivariate Cox-regression analysis, age (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.05-1.10) and dialysis (HR 6.18; 95%CI 3.40-11.25) were independently associated with death, while first implant was associated with a lower risk as compared to subsequent procedures (HR 0.63; 95%CI 0.46-0.85) (Figure 1). Conclusions In large contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED infections was low.