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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:355-62 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.09.031

Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center

Encarnación Gutiérrez Carretero a, Eduardo Arana Rueda b, José Manuel Lomas Cabezas c, Fernando Laviana Martínez a, Manuel Villa Gil-Ortega d, Jesús Acosta Martínez e, Alonso Pedrote Martínez b, Arístides de Alarcón González f,

a Servicio de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Unidad de Electrofisiología, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Infectious Diseases Department, Oxford University Hospitals, NHS Foundation Trust, United Kingdom
d Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
e Servicio de Anestesia y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
f Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Grupo de Investigación en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla, Sevilla, Spain

Refers to

Cardiac Device Infections: Accepted Concepts and Controversial Issues
J. Alberto San Román, Jerónimo Rubio
Rev Esp Cardiol. 2017;70:320-2
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Keywords

Infection. Pacemakers. Defibrillators. Percutaneous lead extraction.

Abstract

Introduction and objectives

Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience.

Methods

Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge.

Results

Percutaneous traction (PCT) was the most frequent procedure (n = 280) in local (n = 166) and systemic infections (n = 114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure).

Conclusions

Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved