title: Epicardial cardiac rhythm devices for dialysis patients: minimizing the risk of infection and preserving central veins.
abstract: Transvenous leads of cardiac rhythm devices (CRDs) are known to cause central stenosis and are vulnerable to contamination during hemodialysis access-related bacteremia. In this retrospective study, nine consecutive chronic hemodialysis patients with transvenous CRD infection due to dialysis access-related bacteremia and recurrent central stenosis are presented. Four patients with tunneled hemodialysis catheters (TDCs) and three with arteriovenous grafts experienced access-related bacteremia that spread to the transvenous CRD. Two patients required repeated angioplasty procedures (less than 3 months apart) for central venous stenosis. Transvenous CRD was removed and replaced with an epicardial system in all. One patient with TDC switched to peritoneal dialysis and did not experience infection of the epicardial system despite two episodes of peritonitis. The remaining TDC (n=3) and graft patients (n=3) received a new TDC after the resolution of bacteremia. While all six experienced on average 1.5 episodes of catheter-related bacteremia (average follow-up = 14.5 months), none developed infection of the epicardial system. The patients with central stenosis have required only one angioplasty each for the past 8 and 6 months. To the best of our knowledge this is the first study to suggest that an epicardial approach might be a preferred method over transvenous leads for chronic hemodialysis patients.
authors.affiliation: Department of Interventional Nephrology, University of Miami Miller School of Medicine, Miami, FL 33136, USA. aasif@med.miami.edu
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
authors.forename: Roger
authors.initials: R
authors.lastname: Carrillo
authors.forename: Juan-Domingo
authors.initials: JD
authors.lastname: Garisto
authors.forename: Gustavo
authors.initials: G
authors.lastname: Lopera
authors.forename: Marco
authors.initials: M
authors.lastname: Ladino
authors.forename: Urwa
authors.initials: U
authors.lastname: Barakat
authors.forename: Nadia
authors.initials: N
authors.lastname: Eid
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D001419:Bacteria / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D010496:Pericardium; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors