Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark.
Europace. 2017 Jun 1;19(6):1007-1014. doi: 10.1093/europace/euw404.
To determine the incidence, risk factors, and mortality of infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED).
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.
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.
确定首次植入永久性心脏植入式电子设备（CIED）后感染性心内膜炎（IE）的发生率、风险因素和死亡率。
从丹麦全国性行政登记处（始于 1996 年）中，我们确定了 2000-2012 年期间所有新植入的永久性起搏器（PM）和植入式心脏复律除颤器（ICD）以及植入后 IE 事件的发生情况。共纳入 43048 名首次 PM/ICD 接受者。总随访时间为 168343 人年（PY）。PM 的 IE 发生率（每 1000 PY）为单腔设备 2.1（95%置信区间[CI]：1.7-2.6），心脏再同步治疗（CRT）为 6.2（95%CI：4.5-8.7）；同样，ICD 中 IE 的发生率为单腔设备 3.7（95%CI：2.9-4.7），CRT 为 6.3（95%CI：4.4-9.0）。多变量分析显示，PM 复杂性增加是 IE 的独立危险因素[双腔 PM[风险比（HR）1.39；95%CI：1.07-1.80]和 CRT[HR：1.84；95%CI：1.20-2.84]。随访期间，PM 中的发电机更换（HR：2.79；95%CI：1.87-4.17）和导联修订（HR：4.33；95%CI：3.25-5.78）与风险增加相关。ICD 中的相应估计值分别为 2.49（95%CI：1.28-4.86）和 6.58（95%CI：4.49-9.63）。IE 后死亡的风险在 PM 和 ICD 中显著增加，HR 分别为 1.56（95%CI：1.33-1.82）和 2.63（95%CI：2.00-3.48）。
PM 复杂性增加，IE 风险增加。其他重要的危险因素是随后的发电机更换和导联修订。IE 与 CIED 区域的死亡率增加相关。
