title: Device-related infective endocarditis in cardiac resynchronization therapy recipients - Single center registry with over 2500 person-years follow up.
abstract: To assess incidence, predisposing factors and outcomes of cardiac device-related infective endocarditis (CDRIE) in patients undergoing cardiac resynchronization therapy (CRT).
  
  
  
  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 [ICD], 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%CI 1.93–9.57; and HR 2.43, 95%CI 1.32–4.49, respectively). In the second model (including all differences with P < 0.2) up-grade from ICD (HR 4.36, 95%CI 1.96–9.69), higher NYHA class (HR 2.04, 95%CI 1.11–3.75), hypertrophic cardiomyopathy (HR 5.85, 95% CI 1.46–23.52), lower baseline hemoglobin level (HR 0.68, 95%CI 0.50–0.94) and chronic obstructive pulmonary disease (HR 2.46, 95%CI 1.05–5.77) were all independently associated with higher risk of CDRIE. All-cause mortality in patients with CDRIE was significantly higher than in subjects without infective complications (68.4% vs. 33.7%, P < 0.001), and 50% of patients with CDRIE died during index hospitalization.
  
  
  
  The prevalence of CDRIE in CRT recipients is almost 5% within 3.5 years post implantation. Up-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.
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland. Electronic address: ewajczyk@op.pl.
authors.forename: Ewa
authors.initials: E
authors.lastname: Jędrzejczyk-Patej
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Mazurek
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland; Kardio-Med Silesia, Zabrze, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Sokal
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Kozieł
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Adamczyk
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Przybylska-Siedlecka
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Morawski
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Liberska
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Podolecki
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.affiliation: Department of Cardiology, School of Medicine with the Division of Dentistry, Zabrze, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects* / Q000401:mortality* / Q000639:trends; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects* / Q000382:microbiology / Q000639:trends; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D004866:Equipment Contamination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate / Q000639:trends
keywords: Cardiac resynchronization therapy; Device-related infective endocarditis; Heart failure; Incidence; Risk factors