Device-related infective endocarditis in cardiac resynchronization therapy recipients - Single center registry with over 2500 person-years follow up

Aim: To assess incidence, predisposing factors and outcomes of cardiac device-related infective endocarditis (CDRIE) in patients undergoing cardiac resynchronization therapy (CRT). Methods and results: High-volume, single-center cardiology database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 13.7% and 15.5% up-grades from pacemaker and implantable cardioverter-defibrillator [LCD], respectively). During the median follow-up (FU) of 1207 days (range: 256-2664) overall 38 CDRIE (4.97%) cases were identified (incidence: 15/1000 person-years). Multivariate Cox regression model, incorporating significant baseline differences as covariates (model 1), demonstrated that both up-grade from ICD to CRT and higher baseline NYHA class were independently associated with increased risk of CDRIE (adjusted HR 4.29, 95%Cl 1.93-9.57; and HR 243, 95%0 1.32-4A9, respectively). In the second model (including all differences with P < 0.2) upgrade from ICD (HR 436, 5 Cl 1.96-9.69), higher NYHA class (HR 2.04, 95%Cl 1.11-375), hypertrophic cardiomyopathy (HR 5.85, 95% CI 1A6-23.52), lower baseline hemoglobin level (HR 0.68, 95%Cl 0.50-0.94) and chronic obstructive pulmonary disease (HR 2.46,)5 CI 1.05-5.77) were all independently associated with higher risk of CDRIE. All causemortality in patients with CDRIE was significantly higher than in subjects without infective complications (68A% vs. 33.7%, P < 0.001), and 50% of patients with CDRIE died during index hospitalization. Conclusions: The prevalence of CDRIE in CRT recipients is almost 5% within 3.5 years post implantation, lip-grade from ICD and high baseline NYHA class flag up patients at high-risk of CDRIE. CRT-related infective complications are associated with very poor prognosis. (C) 2016 Elsevier Ireland LLcl. All rights reserved.