Rate of permanent cardiac implantable electronic device infections after active fixation temporary transvenous pacing: A nationwide Danish cohort study

Maria Hee Jung Park Frausing; Jens Cosedis Nielsen; Jens Brock Johansen; Ole Dan Jørgensen; Thomas Olsen; Christian Gerdes; Jens Kristensen; Mads Brix Kronborg

doi:10.1016/j.hroo.2021.11.008

Rate of permanent cardiac implantable electronic device infections after active fixation temporary transvenous pacing: A nationwide Danish cohort study

Heart Rhythm O2. 2021 Nov 18;3(1):50-56. doi: 10.1016/j.hroo.2021.11.008. eCollection 2022 Feb.

Authors

Maria Hee Jung Park Frausing¹, Jens Cosedis Nielsen¹, Jens Brock Johansen², Ole Dan Jørgensen³, Thomas Olsen², Christian Gerdes¹, Jens Kristensen¹, Mads Brix Kronborg¹

Affiliations

¹ Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
² Department of Cardiology, Odense University Hospital, Odense, Denmark.
³ Department of Cardio-Thoracic- and Vascular Surgery, Odense, Denmark.

Abstract

Background: Temporary transvenous pacing (TP) has been associated with an increased risk of cardiac implantable electronic device (CIED) infections, but there is little data to document this in contemporary populations.

Objective: To investigate the impact of active fixation TP on rate of CIED infections in a nationwide cohort of Danish patients.

Methods: We identified all patients who underwent a first-time CIED implantation between 2009 and 2017. Patients were categorized according to TP status at implantation and followed for 1 year. The primary outcome was local or systemic CIED infection resulting in device system removal. The secondary outcomes were systemic CIED infections and hospitalization for infective endocarditis (IE).

Results: We included a total of 40,601 CIED patients. A total of 2952 were treated with active fixation TP. The primary outcome was met in 246 patients. Risk of CIED infection at 1 year was 0.61% for patients not treated with TP and 0.65% for patients who were, HR of 1.28 (95% CI 0.80-2.05) and adjusted HR 0.85 (95% CI 0.51-1.42). More systemic CIED infections and IE hospitalizations occurred in TP patients; however, these differences did not persist after confounder adjustment. Cumulative mortality at 1 year was 16.8% in patients with TP vs 8.4% in patients without.

Conclusion: Active fixation TP was not associated with a higher rate of CIED infections. Patients treated with TP had higher mortality, more systemic CIED infections, and more IE hospitalizations within first year of implantation. Most was attributable to an accumulation of risk factors for infection among TP patients.

Keywords: Cardiac implantable electronic device; Complications; Epidemiology; Infection; Infective endocarditis; Pacemaker; Temporary transvenous pacing.