INFECTIONS WITH NONTHORACOTOMY IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS - CAN THESE BE PREVENTED

Nonthoracotomy ICDs are believed to be the best therapeutic modality f or treatment of life-threatening ventricular arrhythmias. Little is kn own about the risk of infection with initial implantation of these dev ices. We studied the incidence, clinical characteristics, and risk fac tors associated with infections in 1,831 patients with nonthoracotomy ICD from the Endotak-C nonthoracotomy lead registry of Cardiac Pacemak ers, Inc. A transvenous lead was implanted in 950 patients (51.9%) and a combination transvenous plus subcutaneous patch was used in 881 pat ients (48.1%). Nine preselected data variables were studied, and all i nvestigators identified as having patients with infections rt ere pers onally contacted. Infections occurred in 22 (1.2%) of 1,831 patients r eceiving this nonthoracotomy ICD system. The mean time to infection wa s 5.7 +/- 6.5 months (range 1-25 months). Staphylococci were isolated in 58% of patients with reported infection. The presence of a subcutan eous defibrillator patch system was associated with the development of infection. Six of 950 patients (0.63%) with a totally transvenous lea d system developed infection versus 16 of 838 (1.9%) patients with a t ransvenous lead plus subcutaneous patch system configuration (P = 0.01 5, Chi-square test), with an unadjusted estimated odds ratio of 3.06 ( CI 1.19-7.86). The risk of infection encountered with the nonthoracoto my ICD is low, estimated from our data to be 1.2%. Placement of a subc utaneous defibrillator patch appears to be an independent risk factor for development of infection.