title: Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study.
abstract: OBJECTIVE
  To determine the incidence, risk factors, and mortality of infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED).
  
  
  RESULTS
  From Danish nationwide administrative registers (beginning in 1996), we identified all de-novo permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) together with the occurrence of post-implantation IE-events in the period from 2000-2012. Included were 43 048 first-time PM/ICD recipients. Total follow-up time was 168 343 person-years (PYs). The incidence rate (per 1000 PYs) of IE in PM was 2.1 (95% confidence interval [CI]: 1.7-2.6) for single chamber devices and 6.2 (95% CI: 4.5-8.7) for cardiac resynchronization therapy (CRT); similarly, the rate of IE in ICD was 3.7 (95% CI: 2.9-4.7) in single chamber devices and 6.3 (95% CI: 4.4-9.0) in CRT. In multivariable analysis, increased PM complexity served as independent risk factor for IE {dual chamber PM [hazard ratio (HR) 1.39; 95% CI: 1.07-1.80] and CRT [HR: 1.84; 95% CI: 1.20-2.84]}. During follow-up, generator replacement (HR: 2.79; 95% CI: 1.87-4.17) and lead revision (HR: 4.33; 95% CI: 3.25-5.78) in PMs were associated with increased risk. Corresponding estimates in ICDs were 2.49 (95% CI: 1.28-4.86) and 6.58 (95% CI: 4.49-9.63). Risk of death after IE was significantly increased in PM and ICD with HRs of 1.56 (95% CI: 1.33-1.82) and 2.63 (95% CI: 2.00-3.48), respectively.
  
  
  CONCLUSIONS
  The risk of IE increased with increasing PM complexity. Other important risk factors were subsequent generator replacement and lead revision. IE was associated with an increased risk of mortality in the area of CIED.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Özcan
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Raunsø
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.|Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.affiliation: Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen Ø, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
authors.forename: Tommi Bo
authors.initials: TB
authors.lastname: Lindhardt
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.|Clinical Institute, Aalborg University, 9000 Aalborg, Denmark.
authors.forename: Niels Eske
authors.initials: NE
authors.lastname: Bruun
authors.affiliation: Department of Cardiology, Odense University Hospital, 5000 Odense C, Denmark.
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Laursen
authors.affiliation: Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
authors.forename: Gunnar Hilmar
authors.initials: GH
authors.lastname: Gislason
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable / Q000009:adverse effects; D003718:Denmark / Q000453:epidemiology; D020878:Device Removal; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Implantable cardioverter defibrillator; Incidence; Infective endocarditis; Mortality; Pacemaker; Risk factors