A simple infection-control protocol to reduce serious cardiac device infections.

AIM: Device infection is a serious complication and is considered procedure-related if occurring within 12 months of an intervention. We analysed the effectiveness of a simple infection-control protocol (ICP) at reducing cardiac device infections (CDIs) in a tertiary referral centre. METHODS AND RESULTS: Prior to the introduction of a new ICP, we retrospectively analysed all simple and complex device implants, related procedures, and infections over a 3-year period. A new protocol was implemented from November 2007, including antibiotic prophylaxis determined by risk stratification, improved glycaemic control, specific skin preparation, and closure techniques, as well as different diathermy settings. Follow-up data for all patients were collected. Risk factors for infection were compared between pre- and post-intervention groups to ensure that the populations were comparable. A cost analysis of CDI and a review of the commonly identified micro-organisms were also undertaken. One thousand seven hundred and ninety-eight procedures were performed between November 2004 and November 2007 and 981 procedures between November 2007 and May 2009. There were no significant differences in the risk factors for infection between the two groups. Following the introduction of the ICP, there was a 54% reduction in the incidence of CDI from 1.3 to 0.6% (P < 0.03; CI 0.25, 1.36). Most patients with CDI had negative blood cultures or grew Staphylococcus sp. The average cost was £30 958.40 per infection incident and the cost of the new ICP was minimal. CONCLUSIONS: A significant reduction in CDI can be achieved with the introduction of a simple ICP with substantial cost savings.

An 8-year single-centre experience of cardiac resynchronisation therapy: procedural success, early and late complications, and left ventricular lead performance.

AIMS: Despite the increasing number of device implants worldwide, little is known about the early and late complications of cardiac resynchronisation therapy (CRT) or the incidence of these complications in patients with different heart failure aetiologies. We aim to determine procedural success and early and late complications in CRT patients. METHODS AND RESULTS: All early (<90 days) and late (>90 days) complications occurring over 490 consecutive CRT procedures in 402 patients, from a large single-centre registry between 2000 and 2009 were analysed. Mean follow-up duration was 1012 ± 610 days. In addition, procedural data and long-term left ventricular (LV) lead performance were examined. The mean age of patients was 65 ± 15 years, 31% were female. The majority of devices (70%) were CRT-defibrillators. Left ventricular lead implantation was achieved after one or more than one attempt in 96.7% of patients (first procedure was successful in 95.1%). The incidence of early and late complications was 9.4% and 6.1% respectively. Infection and lead displacement were the most common complications. Dilated cardiomyopathy (DCM) was associated with significantly more complications than ischaemic cardiomyopathy (P = 0.01) and these occurred later in the DCM population. Long-term LV lead performance was comparable with that of right atrial and ventricular leads. CONCLUSION: Transvenous implantation of the LV lead is safe and achievable for CRT with high procedural success rates. For the first time we describe the late complications from CRT in different heart failure populations. This group of patients must be kept under surveillance, not only for heart failure events but also for device-related issues. The reasons for higher complication rates in DCM patients require further evaluation.