Efficacy of the antibacterial envelope to prevent cardiac implantable electronic device infection in a high-risk population. Issue 12 (22nd August 2022)

• Record Type: Journal Article
• Authors: Chaudhry, Uzma; Borgquist, Rasmus; Smith, J Gustav; Mörtsell, David
• Is Part Of: Europace. Volume 24:Issue 12(2022)
• Page Start: 1973
• Page End: 1980
• Publication Date: 2022-08-22
• Subjects: Cardiac implantable electronic device -- Infection -- An antibiotic-eluting absorbable envelope -- TYRX -- Health economy; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac119
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Infection is a serious complication of cardiac implantable electronic device (CIED) therapy. An antibiotic-eluting absorbable envelope has been developed to reduce the infection rate, but studies investigating the efficacy and a reasonable number needed to treat in high-risk populations for infections are limited. Methods and results: One hundred and forty-four patients undergoing CIED implantation who received the antibacterial envelope were compared with a matched cohort of 382 CIED patients from our institution. The primary outcome was the occurrence of local infection, and secondary outcomes were any CIED-related local or systemic infections, including endocarditis, and all-cause mortality. The results were stratified by a risk score for CIED infection, PADIT. The envelope group had a higher PADIT score, 5.9 ± 3.1 vs. 3.9 ± 3.0 ( P < 0.0001). For the primary endpoint, no local infections occurred in the envelope group, compared with 2.6% in the control group ( P = 0.04), with a more pronounced difference in the stratum with a high (>7 points) PADIT score, 0 vs. 9.9% ( P = 0.01). The total CIED-related infections were similar between groups, 6.3% compared with 5.0% ( P = 0.567). Mortality after 1600 days of follow-up did not differ between groups, 22.9 vs. 26.4%, P = 0.475. Conclusion: Our study confirms the clinical efficacy of an antibacterial envelope in the prevention of local CIED infection in patients with a higher risk according to the PADIT score. In an effort to improve cost–benefit ratios, ration of use guided by the PADIT score is advocated. Further prospective randomized studies in high-risk populations are called for. Graphical Abstract: Graphical Abstract