Risk Factors for CIED Infection After Secondary Procedures: Insights From the WRAP-IT Trial.

OBJECTIVES

This study aimed to identify risk factors for infection after secondary cardiac implantable electronic device (CIED) procedures.

BACKGROUND

Risk factors for CIED infection are not well defined and techniques to minimize infection lack supportive evidence. WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial), a large study that assessed the safety and efficacy of an antibacterial envelope for CIED infection reduction, offers insight into procedural details and infection prevention strategies.

METHODS

This analysis included 2,803 control patients from the WRAP-IT trial who received standard preoperative antibiotics but not the envelope (44 patients with major infections through all follow-up). A multivariate least absolute shrinkage and selection operator machine learning model, controlling for patient characteristics and procedural variables, was used for risk factor selection and identification. Risk factors consistently retaining predictive value in the model (appeared >10 times) across 100 iterations of imputed data were deemed significant.

RESULTS

Of the 81 variables screened, 17 were identified as risk factors with 6 being patient/device-related (nonmodifiable) and 11 begin procedure-related (potentially modifiable). Patient/device-related factors included higher number of previous CIED procedures, history of atrial arrhythmia, geography (outside North America and Europe), device type, and lower body mass index. Procedural factors associated with increased risk included longer procedure time, implant location (non-left pectoral subcutaneous), perioperative glycopeptide antibiotic versus nonglycopeptide, anticoagulant, and/or antiplatelet use, and capsulectomy. Factors associated with decreased risk of infection included chlorhexidine skin preparation and antibiotic pocket wash.

CONCLUSIONS

In WRAP-IT patients, we observed that several procedural risk factors correlated with infection risk. These results can help guide infection prevention strategies to minimize infections associated with secondary CIED procedures.

Informations de copyright

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Supported by Medtronic, Inc. Dr Tarakiji has received honoraria/consultant fees from AliveCor and Medtronic outside the submitted work. Dr Krahn has received honoraria/consultant fees from Medtronic outside the submitted work. Dr Poole has received honoraria/consultant fees from Boston Scientific, EBR Solutions, Kestra, and Medtronic outside the submitted work. Dr Mittal has received honoraria/consultant fees from Abbott, Boston Scientific, and Medtronic outside the submitted work. Dr Kennergren has received honoraria/consultant fees from Biotronik, Boston Scientific, Medtronic, and Philips outside the submitted work. Dr Biffi has received honoraria/consultant fees from Boston Scientific, Biotronik, and Medtronic outside the submitted work. Drs Korantzopoulos and Dallaglio have received honoraria/consultant fees from Medtronic outside the submitted work. Drs Lexcen and Lande and Mrs Hilleren and Holbrook have received personal fees from Medtronic. Dr Wilkoff has received honoraria/consultant fees from Abbott, Medtronic, and Philips outside the submitted work.