Cardiac implantable electronic device and associated risk of infective endocarditis in patients undergoing aortic valve replacement. Issue 10 (25th December 2017)

• Record Type: Journal Article
• Authors: Østergaard, Lauge; Valeur, Nana; Bundgaard, Henning; Gislason, Gunnar; Torp-Pedersen, Christian; Eske Bruun, Niels; Køber, Lars; Fosbøl, Emil Loldrup
• Is Part Of: Europace. Volume 20:Issue 10(2018)
• Page Start: e164
• Page End: e170
• Publication Date: 2017-12-25
• Subjects: Infective endocarditis -- Aortic valve replacement -- Cardiac implantable electronic device -- Incidence; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/eux360
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Patients undergoing aortic valve replacement (AVR) are at increased risk of infective endocarditis (IE) as are patients with a cardiac implantable electronic device (CIED). However, few data exist on the IE risk after AVR surgery in patients with a CIED. Methods and results: Using the Danish administrative registries, we identified patients undergoing AVR from January 1996 to December 2015. Patients were categorized by CIED and non-CIED and followed up till hospitalization due to IE, death, 10 years after AVR discharge, end of study period (December 2015) or emigration, whichever came first. Using multivariable-adjusted Cox proportional hazard analysis with time-varying exposure, we investigated whether CIED was associated with an increased risk of IE. We included 15 538 patients (median age 71.4 years, 25th–75th percentiles 63.7–77.1, and 65.2% male). There were 890 patients with a CIED; 531 of these received their device during the AVR hospitalization and 14 648 patients with no CIED. The crude incidence rate of IE was 149.4/10 000 person-years in the CIED group and 74.3/10 000 person-years in the non-CIED group. Overall, CIED was associated with an increased risk of IE (hazard ratio 1.66, 95% confidence interval 1.27–2.17). There was no difference in associated IE according to the timing of CIED ( P for interaction = 0.21 for CIED implantation before vs. in conjunction with AVR surgery). Conclusion: Patients with a CIED who underwent surgery for AVR were associated with an increased risk of IE compared with patients without a CIED. The association was independent of the timing of CIED implantation (before or in conjunction with AVR surgery).