Infection Predictors and Outcomes in Subcutaneous Implantable Cardioverter Defibrillator Patients
Gold MR, Aasbo JD, Weiss R, Burke MC, Gleva MJ, Knight BP, Miller MA, Schuger CD, Carter N, Leigh J, Hansen LK, and El-Chami MF. Infection Predictors and Outcomes in Subcutaneous Implantable Cardioverter Defibrillator Patients. Heart Rhythm 2019; 16(5):162-163.
Background: Recent studies in the US have shown that the subcutaneous implantable cardioverter defibrillator (S-ICD) is being used in populations with more co-morbidities and at higher risk for infection. Previous studies of infection in the S-ICD have evaluated short term follow-up and healthier patients. Objective: To determine the incidence and predictors of S-ICD-related infection in patients (pts) enrolled in the S-ICD Post-Approval Study (PAS). Methods: The S-ICD PAS is a US prospective registry of 1637 pts across 86 sites. Baseline demographics and outcomes with 1-year post-implant follow-up were compared between pts with and without device-related infection requiring surgical intervention. Multivariate logistic regression analysis was performed to determine infection predictors. Results: Infection was observed in 2.7% of pts. No pt had lead extraction complications or bacteremia related to the device. Baseline demographics and procedure data are compared in the Table between pts with and without infection. Predictors of infection were longer procedure time (p=0.0492), being diabetic (p=0.0091), having a prior defibrillator implant (p<0.0001), and the presence of hematoma post-implant (p=0.0032). In contrast to reports of transvenous ICDs, dialysis was not predictive of S-ICD infection. Conclusion: In this more traditional ICD population, rates of infection were similar to other S-ICD populations and not associated with systemic blood-borne infections. Longer procedure time, diabetes, prior defibrillator implant, and initial development of a hematoma increased infection risk.