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David L. Hayes - One of the best experts on this subject based on the ideXlab platform.
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temporal trends in Permanent Pacemaker implantation a population based study
American Heart Journal, 2008Co-Authors: Daniel Z Uslan, Larry M Baddour, Paul A Friedman, Imad M Tleyjeh, Sarah M Jenkins, Jennifer L St Sauver, David L. HayesAbstract:Background Limited data exist regarding temporal trends in Permanent Pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period. Methods All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent Pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population. Results Adjusted implantation incidence rates increased from 36.6 per 100 000 person-years during 1975 to 1979 to 99 per 100 000 person-years during 2000 to 2004 ( P P P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases ( P P = .047). Conclusions There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.
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infective endocarditis complicating Permanent Pacemaker and implantable cardioverter defibrillator infection
Mayo Clinic Proceedings, 2008Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Jenkins, Larry M BaddourAbstract:OBJECTIVE To describe management of patients with Permanent Pacemaker (PPM)- and implantable cardioverter-defibrillator (ICD)-related endocarditis. PATIENTS AND METHODS We retrospectively reviewed all cases of infection involving PPMs and ICDs among patients presenting to Mayo Clinic's site in Rochester, MN, between January 1, 1991, and December 31, 2003. Cardiac device-related infective endocarditis (CDIE) was defined as the presence of both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE. Of 189 patients with PPM or ICD infection who were admitted during the study period, 44 met the case definition for CDIE (33 PPM, 11 ICD). RESULTS The mean ± SD age of patients was 67±14 years. Staphylococci (36 [82%]) were the most commonly isolated pathogens. Nearly all patients (43 [98%]) were treated with a combined approach of complete hardware removal and parenteral antibiotics. The median duration of antibiotic treatment after infected device explantation was 28 days (interquartile range, 19-42 days). Device leads were removed percutaneously in 34 cases (77%); only 7 cases (16%) required surgical lead extraction. Percutaneous extraction was uncomplicated in 15 patients with lead vegetation greater than 10 mm in diameter. Six patients (14%) died during hospitalization. Twenty-seven (96%) of 28 patients remained infection free at their last visit (median follow-up, 183 days; intraquartile range, 36-628 days). CONCLUSION Prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with CDIE. The presence of a large (>10 mm in diameter) vegetation on a lead is not a contraindication for percutaneous lead extraction. This study found that prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with cardiac device-related infective endocarditis.
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risk factor analysis of Permanent Pacemaker infection
Clinical Infectious Diseases, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Background. Several host- and procedure-related factors have been reported to increase the risk of Permanent Pacemaker (PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods.Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection.Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM-related endocarditis. Staphylococcus species (69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a Permanent central venous catheter, the presence of >2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use (odds ratio [OR], 13.90; 95% confidence interval [CI], 1.27-151.7; P=.03) and the presence of >2 pacing leads versus 2 leads (OR, 5.41; 95% CI, 1.44-20.29; P=.01) as independent risk factors for PPM infection. In contrast, use of antibiotic prophylaxis prior to PPM implantation had a protective effect (OR, 0.087; 95% CI, 0.016-0.48; P=.005).Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.
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management and outcome of Permanent Pacemaker and implantable cardioverter defibrillator infections
Journal of the American College of Cardiology, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Objectives We describe the management and outcome of Permanent Pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction. Background Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined. Methods A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed. Results A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus , in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p Conclusions Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
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incidence and predictors of cardiac perforation after Permanent Pacemaker placement
Heart Rhythm, 2005Co-Authors: Srijoy Mahapatra, Kevin A Bybee, Jared T Bunch, Raul E Espinosa, Lawrence J Sinak, Michael D Mcgoon, David L. HayesAbstract:Background Pericardial effusion, a sign of cardiac perforation, may complicate Permanent Pacemaker placement. Risk factors for development of post-Permanent Pacemaker effusion have not been evaluated. Objectives The purpose of this study was to determine the predictors of symptomatic pericardial effusion after Permanent Pacemaker placement. Methods The Mayo Clinic Pacemaker and echocardiogram databases were cross-referenced. From 1995 to 2003, 4,280 Permanent Pacemakers were implanted. Fifty (1.2%) patients developed significant effusion and symptoms consistent with perforation. They were randomly matched with 100 patients without effusion after Permanent Pacemaker placement. Results The strongest predictors of postimplant effusion by univariate analysis were the concomitant use of a temporary transvenous Pacemaker (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.6–6.2, P = .001) or steroid use within 7 days prior to implant (HR 4.1, 95% CI 1.1–10, P = .003). Weaker predictors were use of helical screw ventricular leads, body mass index (BMI) 35 mmHg (HR 0.70, 95% CI 0.44–0.97, P = .01) or BMI >30 (HR 0.62, 95% CI 0.41–0.93, P = .01). Multivariate predictors were use of temporary Pacemaker (HR 2.7, 95% CI 1.4–3.9, P = .01), helical screw leads (HR 2.5; 95% CI 1.4-3.8, P = .04), and steroids (HR 3.2, 95% CI 1.1–5.4, P = .04). Right ventricular systolic pressure >35 mmHg was the only protective factor (HR 0.70, 95% CI 0.50–0.92, P = .02). Conclusion The incidence of postimplant effusions is low. In order to minimize periprocedural Permanent Pacemaker effusions, temporary Pacemaker placement should be avoided unless essential, and particular care should be taken when placing a Permanent Pacemaker in patients who are taking steroids.
Keith D Dawkins - One of the best experts on this subject based on the ideXlab platform.
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Permanent Pacemaker implantation after isolated aortic valve replacement incidence indications and predictors
The Annals of Thoracic Surgery, 2008Co-Authors: Sam Dawkins, Alex Hobson, Paul R Kalra, Augustine T M Tang, J L Monro, Keith D DawkinsAbstract:Background Conducting system defects are common in patients with aortic valve disease. Aortic valve replacement may result in further conduction abnormalities and necessitate Permanent Pacemaker implantation (PPM). We sought to identify the contemporary incidence and predictors for early postoperative PPM in patients undergoing isolated aortic valve replacement. Methods Data were analyzed from 354 consecutive patients undergoing isolated aortic valve replacement at a referral cardiac unit during a 30-month period; data were unavailable on 4 patients and a further 8 had undergone preoperative PPM. Results for the remaining 342 patients (97%; mean age, 67 ± 14 years), of whom 212 were males, are presented. The major indications for aortic valve replacement were valvular stenosis (n = 224), regurgitation (n = 70), or infective endocarditis (n = 25). Preoperative conducting system disease was present in 26% of patients. Results In-hospital mortality was 1.8% (6 of 342 patients). Postoperatively 29 patients (8.5%) required early PPM, of which 26 were during the index admission. Patients with preoperative conducting system disease (16% versus 6%; p = 0.004) and valvular regurgitation (16% versus 7%; p = 0.01) were more likely to require PPM as opposed to those without. Preoperative conducting system disease was the only independent predictor of PPM ( p Conclusions Permanent Pacemaker implantation requirement after aortic valve replacement is a common occurrence, and should be discussed as part of the preoperative consent process. Preexisting conducting disease and preoperative aortic regurgitation were predictors of PPM requirement.
Jan Kovac - One of the best experts on this subject based on the ideXlab platform.
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conduction abnormalities and Permanent Pacemaker implantation after transcatheter aortic valve replacement using the repositionable lotus device the united kingdom experience
Jacc-cardiovascular Interventions, 2017Co-Authors: Rajiv Rampat, Jan Kovac, Zeeshan M Khawaja, Roland Hillingsmith, Jonathan Byrne, Philip Maccarthy, Daniel J Blackman, Arvindra Krishnamurthy, Ashan Gunarathne, Adrian P BanningAbstract:Abstract Objectives The authors report the incidence of Pacemaker implantation up to hospital discharge and the factors influencing pacing rate following implantation of the LOTUS bioprosthesis (Boston Scientific, Natick, Massachusetts) in the United Kingdom. Background Transcatheter aortic valve replacement (TAVR) is associated with a significant need for Permanent Pacemaker implantation. Pacing rates vary according to the device used. The REPRISE II (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System) trial reported a pacing rate of 29% at 30 days after implantation of the LOTUS device. Methods Data were collected retrospectively on 228 patients who had the LOTUS device implanted between March 2013 and February 2015 across 10 centers in the United Kingdom. Twenty-seven patients (12%) had Pacemakers implanted pre-procedure and were excluded from the analysis. Results Patients were aged 81.2 ± 7.7 years; 50.7% were male. The mean pre-procedural QRS duration was 101.7 ± 20.4 ms. More than one-half of the cohort (n = 111, 55%) developed new left bundle branch block (LBBB) following the procedure. Permanent Pacemakers were implanted in 64 patients (32%) with a median time to insertion of 3.0 ± 3.4 days. Chief indications for pacing were atrioventricular (AV) block (n = 46, 72%), or LBBB with 1st degree AV block (n = 11, 17%). Amongst those who received a Pacemaker following TAVR the pre-procedural electrocardiogram findings included: No conduction disturbance (n = 41, 64%); 1st degree AV block (n = 10, 16%); right bundle branch block (n = 6, 9%) and LBBB (n = 5, 8%). LBBB (but not Permanent Pacemaker) occurred more frequently in patients who had balloon aortic valvuloplasty before TAVR (odds ratio [OR]: 1.25; p = 0.03). Pre-procedural conduction abnormality (composite of 1st degree AV block, hemiblock, right bundle branch block, LBBB) was independently associated with the need for Permanent Pacemaker (OR: 2.54; p = 0.048). The absence of aortic valve calcification was also associated with a higher pacing rate (OR: 0.55; p = 0.031). Multivariate regression analysis did not show an independent association between depth of implant, valve oversizing, balloon post-dilatation, and the need for pacing post-procedure. Conclusions Following implantation of the repositionable LOTUS valve, 55% of patients developed LBBB and 32% of patients required a Pacemaker during their index hospital admission. Patients with pre-procedural conduction disturbance and non-calcified aortic valves were more likely to need pacing. No other anatomic features were identified with increased pacing requirement with the LOTUS device.
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predictors for Permanent Pacemaker requirement after transcatheter aortic valve implantation with the corevalve bioprosthesis
American Heart Journal, 2009Co-Authors: Hasan Jilaihawi, Derek Chin, Mariuca Vasanicotera, Mohamed Jeilan, Tomasz Spyt, Andre G Ng, Johan Bence, Elaine Logtens, Jan KovacAbstract:Introduction Changes in atrioventricular (AV) conduction and need for Permanent Pacemaker (PPM) are a recognized complication after open aortic valve replacement. We hypothesized that the need for PPM after CoreValve (Corevalve Inc, Irvine, CA) can be predicted with a combination of baseline variables. Methods In patients undergoing transcatheter aortic valve implantation, potential clinical, electrocardiographic and echocardiographic predictors of Permanent pacing requirement were studied. Results Between January 2007 and March 2008, 34 patients with severe symptomatic aortic stenosis were recruited in a single center. Mean age was 84.4 years (SD 5.4, range 71-93). Of 34 cases paced at baseline, 3 (8.8%) were excluded from this analysis, as was the single periprocedural mortality. Of the remaining 30, 10 underwent Permanent Pacemaker implantation during the same admission (33.3%). PPM was for prolonged high-grade AV block in 4 cases, episodic high-grade AV block in 5, and sinus node disease in 1. Need for Pacemaker was correlated to left axis deviation at baseline ( P = .004, r = 0.508) and left bundle-branch block with left axis deviation ( P = .002, r = 0.548). It was related to diastolic interventricular septal dimension on transthoracic echocardiography >17 mm ( P = .045, r = 0.39) and the baseline thickness of the native noncoronary cusp ( P = .002, r = 0.655). A susceptibility model was generated, and if at least one of (1) left bundle-branch block with left axis deviation, (2) interventricular septal dimension >17 mm, or (3) noncoronary cusp thickness >8 mm was present, the likelihood of PPM could be predicted with 75% sensitivity and 100% specificity and a receiver operating characteristic curve area of 0.93 ± 0.055 ( P Conclusions After transcatheter aortic valve implantation with CoreValve, Permanent pacing was performed in around a third of patients and we present preliminary concepts towards a predictive model for this phenomenon.
Paul A Friedman - One of the best experts on this subject based on the ideXlab platform.
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temporal trends in Permanent Pacemaker implantation a population based study
American Heart Journal, 2008Co-Authors: Daniel Z Uslan, Larry M Baddour, Paul A Friedman, Imad M Tleyjeh, Sarah M Jenkins, Jennifer L St Sauver, David L. HayesAbstract:Background Limited data exist regarding temporal trends in Permanent Pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period. Methods All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent Pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population. Results Adjusted implantation incidence rates increased from 36.6 per 100 000 person-years during 1975 to 1979 to 99 per 100 000 person-years during 2000 to 2004 ( P P P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases ( P P = .047). Conclusions There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.
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infective endocarditis complicating Permanent Pacemaker and implantable cardioverter defibrillator infection
Mayo Clinic Proceedings, 2008Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Jenkins, Larry M BaddourAbstract:OBJECTIVE To describe management of patients with Permanent Pacemaker (PPM)- and implantable cardioverter-defibrillator (ICD)-related endocarditis. PATIENTS AND METHODS We retrospectively reviewed all cases of infection involving PPMs and ICDs among patients presenting to Mayo Clinic's site in Rochester, MN, between January 1, 1991, and December 31, 2003. Cardiac device-related infective endocarditis (CDIE) was defined as the presence of both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE. Of 189 patients with PPM or ICD infection who were admitted during the study period, 44 met the case definition for CDIE (33 PPM, 11 ICD). RESULTS The mean ± SD age of patients was 67±14 years. Staphylococci (36 [82%]) were the most commonly isolated pathogens. Nearly all patients (43 [98%]) were treated with a combined approach of complete hardware removal and parenteral antibiotics. The median duration of antibiotic treatment after infected device explantation was 28 days (interquartile range, 19-42 days). Device leads were removed percutaneously in 34 cases (77%); only 7 cases (16%) required surgical lead extraction. Percutaneous extraction was uncomplicated in 15 patients with lead vegetation greater than 10 mm in diameter. Six patients (14%) died during hospitalization. Twenty-seven (96%) of 28 patients remained infection free at their last visit (median follow-up, 183 days; intraquartile range, 36-628 days). CONCLUSION Prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with CDIE. The presence of a large (>10 mm in diameter) vegetation on a lead is not a contraindication for percutaneous lead extraction. This study found that prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with cardiac device-related infective endocarditis.
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risk factor analysis of Permanent Pacemaker infection
Clinical Infectious Diseases, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Background. Several host- and procedure-related factors have been reported to increase the risk of Permanent Pacemaker (PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods.Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection.Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM-related endocarditis. Staphylococcus species (69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a Permanent central venous catheter, the presence of >2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use (odds ratio [OR], 13.90; 95% confidence interval [CI], 1.27-151.7; P=.03) and the presence of >2 pacing leads versus 2 leads (OR, 5.41; 95% CI, 1.44-20.29; P=.01) as independent risk factors for PPM infection. In contrast, use of antibiotic prophylaxis prior to PPM implantation had a protective effect (OR, 0.087; 95% CI, 0.016-0.48; P=.005).Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.
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management and outcome of Permanent Pacemaker and implantable cardioverter defibrillator infections
Journal of the American College of Cardiology, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Objectives We describe the management and outcome of Permanent Pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction. Background Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined. Methods A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed. Results A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus , in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p Conclusions Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.
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long term survival after ablation of the atrioventricular node and implantation of a Permanent Pacemaker in patients with atrial fibrillation
The New England Journal of Medicine, 2001Co-Authors: Cevher Ozcan, Paul A Friedman, Arshad Jahangir, Philip J Patel, Thomas M Munger, Robert F Rea, Margaret A Lloyd, Douglas L Packer, David O Hodge, Bernard J GershAbstract:Background In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a Permanent Pacemaker are an alternative therapeutic approach. The effect of this procedure on long-term survival is unknown. Methods We studied all patients who underwent ablation of the atrioventricular node and implantation of a Permanent Pacemaker at the Mayo Clinic between 1990 and 1998. Observed survival was compared with the survival rates in two control populations: age- and sex-matched members of the Minnesota population between 1970 and 1990 and consecutive patients with atrial fibrillation who received drug therapy in 1993. Results A total of 350 patients (mean [±SD] age, 68±11 years) were studied. During a mean of 36±26 months of follow-up, 78 patients died. The observed survival rate was significantly lower than the expected survival rate based on the general Minnesota population (P<0.001). Previous myocardial infarction (P< 0.001), a hi...
Larry M Baddour - One of the best experts on this subject based on the ideXlab platform.
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temporal trends in Permanent Pacemaker implantation a population based study
American Heart Journal, 2008Co-Authors: Daniel Z Uslan, Larry M Baddour, Paul A Friedman, Imad M Tleyjeh, Sarah M Jenkins, Jennifer L St Sauver, David L. HayesAbstract:Background Limited data exist regarding temporal trends in Permanent Pacemaker (PPM) implantation. To describe trends in incidence and comorbidities of PPM recipients, we conducted a retrospective population-based cohort study over a 30-year period. Methods All 1291 adult residents of Olmsted County, Minnesota, undergoing PPM implantation between 1975 and 2004 were included in the study. Trends in PPM implantation incidence, pacing mode and indication, and comorbidities (via Charlson Comorbidity Index [CCI]) were assessed through the Rochester Epidemiology Project. Permanent Pacemaker recipients were compared with age- and sex-matched PPM-free controls from the population. Results Adjusted implantation incidence rates increased from 36.6 per 100 000 person-years during 1975 to 1979 to 99 per 100 000 person-years during 2000 to 2004 ( P P P = .04), with higher mean CCI noted since 1990. Mean age-adjusted CCI increased from 3.15 to 4.60 among the cases ( P P = .047). Conclusions There have been significant increases in incidence of PPM implantation over 30 years, and PPM recipients have had an age-independent increase in comorbidities relative to the underlying population, especially over the past 15 years.
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infective endocarditis complicating Permanent Pacemaker and implantable cardioverter defibrillator infection
Mayo Clinic Proceedings, 2008Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Jenkins, Larry M BaddourAbstract:OBJECTIVE To describe management of patients with Permanent Pacemaker (PPM)- and implantable cardioverter-defibrillator (ICD)-related endocarditis. PATIENTS AND METHODS We retrospectively reviewed all cases of infection involving PPMs and ICDs among patients presenting to Mayo Clinic's site in Rochester, MN, between January 1, 1991, and December 31, 2003. Cardiac device-related infective endocarditis (CDIE) was defined as the presence of both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE. Of 189 patients with PPM or ICD infection who were admitted during the study period, 44 met the case definition for CDIE (33 PPM, 11 ICD). RESULTS The mean ± SD age of patients was 67±14 years. Staphylococci (36 [82%]) were the most commonly isolated pathogens. Nearly all patients (43 [98%]) were treated with a combined approach of complete hardware removal and parenteral antibiotics. The median duration of antibiotic treatment after infected device explantation was 28 days (interquartile range, 19-42 days). Device leads were removed percutaneously in 34 cases (77%); only 7 cases (16%) required surgical lead extraction. Percutaneous extraction was uncomplicated in 15 patients with lead vegetation greater than 10 mm in diameter. Six patients (14%) died during hospitalization. Twenty-seven (96%) of 28 patients remained infection free at their last visit (median follow-up, 183 days; intraquartile range, 36-628 days). CONCLUSION Prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with CDIE. The presence of a large (>10 mm in diameter) vegetation on a lead is not a contraindication for percutaneous lead extraction. This study found that prompt hardware removal and prolonged parenteral antibiotic administration decrease mortality among patients with cardiac device-related infective endocarditis.
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risk factor analysis of Permanent Pacemaker infection
Clinical Infectious Diseases, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Background. Several host- and procedure-related factors have been reported to increase the risk of Permanent Pacemaker (PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods.Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection.Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM-related endocarditis. Staphylococcus species (69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a Permanent central venous catheter, the presence of >2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use (odds ratio [OR], 13.90; 95% confidence interval [CI], 1.27-151.7; P=.03) and the presence of >2 pacing leads versus 2 leads (OR, 5.41; 95% CI, 1.44-20.29; P=.01) as independent risk factors for PPM infection. In contrast, use of antibiotic prophylaxis prior to PPM implantation had a protective effect (OR, 0.087; 95% CI, 0.016-0.48; P=.005).Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.
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management and outcome of Permanent Pacemaker and implantable cardioverter defibrillator infections
Journal of the American College of Cardiology, 2007Co-Authors: Muhammad R Sohail, David L. Hayes, Walter R Wilson, Paul A Friedman, Daniel Z Uslan, James M Steckelberg, Akbar H Khan, Sarah M Stoner, Larry M BaddourAbstract:Objectives We describe the management and outcome of Permanent Pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) infections in a large cohort of patients seen at a tertiary care facility with expertise in device lead extraction. Background Infection is a serious complication of PPM and ICD implantation. Optimal care of patients with these cardiac device infections (CDI) is not well defined. Methods A retrospective review of all patients with CDI admitted to Mayo Clinic Rochester between January 1, 1991, and December 31, 2003, was conducted. Demographic and clinical data were collected, and descriptive analysis was performed. Results A total of 189 patients met the criteria for CDI (138 PPM, 51 ICD). The median age of the patients was 71.2 years. Generator pocket infection (69%) and device-related endocarditis (23%) were the most common clinical presentations. Coagulase-negative staphylococci and Staphylococcus aureus , in 42% and 29% of cases, respectively, were the leading pathogens for CDI. Most patients (98%) underwent complete device removal. Duration of antibiotic therapy after device removal was based on clinical presentation and causative organism (median duration of 18 days for pocket infection vs. 28 days for endocarditis; 28 days for S. aureus infection vs. 14 days for coagulase-negative staphylococci infection [p Conclusions Cure of CDI is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete device removal. Based on findings of our large retrospective institutional survey and previously published data, we submit proposed management guidelines of CDI.