title: Survival of patients with biventricular devices after device infection, extraction, and reimplantation.
abstract: OBJECTIVE
  This study sought to compare outcomes in patients with biventricular device infections who undergo successful treatment including extraction and reimplantation to patients with biventricular devices never known to become infected.
  
  
  BACKGROUND
  Infection of a cardiac implantable electronic device (CIED) is associated with substantial morbidity and mortality. Survival in patients with cardiac resynchronization therapy (CRT) device infections undergoing full system extraction is unknown.
  
  
  METHODS
  We extracted data on all patients undergoing extraction of a biventricular pacing device for an infectious indication at the Cleveland Clinic between February 16, 2000, and June 30, 2011. Survival of patients who presented with a CRT device infection, extraction, and successful reimplantation was compared to that of a large cohort of consecutive patients undergoing initial CRT implantation without a known history of subsequent device-related infection. In addition, long-term outcomes were compared between patients who were extracted and deemed to be cured with and without successful biventricular device reimplantation.
  
  
  RESULTS
  In all, 151 patients underwent biventricular device extraction for infection, of whom 81 were successfully reimplanted. The noninfected cohort consisted of 879 patients. In a multivariate Cox regression model controlling for sex, a history of ischemic cardiomyopathy, creatinine, hemoglobin, beta-blocker use, angiotensin-converting enzyme inhibitor use, and diuretic use, no significant association between subsequent infection with reimplantation and all-cause mortality was noted (p = 0.21). There was a trend toward worse outcomes for patients extracted, deemed cured, and not reimplanted compared to patients with successful CRT reimplantation.
  
  
  CONCLUSIONS
  Patients with a biventricular device infection who are successfully extracted, treated with antibiotics, and reimplanted with a biventricular device have outcomes similar to those of patients with biventricular devices not known to have become infected.
authors.affiliation: Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: jrickar5@jhmi.edu.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Tarakji
authors.affiliation: Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cantillon
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.affiliation: Division of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kanj
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D015331:Cohort Studies; D020878:Device Removal / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000401:mortality; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000628:therapy
keywords: cardiac resynchronization; device infection; extraction; survival