Mortality and Costs of Cardiac Implantable Electronic Device (CIED) Infections According to the Therapeutic Approach: A Single-Center Cohort Study.

Background: Cardiac device infections are serious adverse events associated with considerable morbidity and mortality, significant costs, and increased healthcare utilization. The aim of this study is to calculate the costs of treatment of cardiac implantable electrostimulation device (CIED)-related infections for different types of infection (local or systemic) and therapeutic approaches. Patients and Methods: Single-center cohort (1985-2018). The costs of the CIED-related infections were analyzed according to initial treatment (antimicrobial treatment exclusively, local approach, or transvenous lead extraction (TLE)). Total costs (including those for hospitalization stay, drugs, extraction material, and newly implanted devices) were assigned to each case until its final resolution. Results: A total of 380 cases (233 local and 147 systemic infections) were analyzed. The average cost of systemic infection was EUR 34,086, mainly due to hospitalization (78.5%; mean: 24 ± 14 days), with a mortality rate of 10.8%. Local infection had a mortality rate of 2.5% (mainly related to the extraction procedure) and an average cost of EUR 21,790, which was higher in patients with resynchronization therapy devices and defibrillators (46% of total costs). Surgical procedures limited to the pocket for local infections resulted in a high rate of recurrence (87%), evolved to systemic infections in 48 patients, and had a higher cost compared to TLE (EUR 42,978 vs. EUR 24,699; p < 0.01). Conclusions: The costs of treating CIED-related infections are high and mainly related to the type of treatment and length of hospitalization. Complete device removal is always the most effective approach and is a cost-saving strategy.

Infecciones en dispositivos de estimulación cardiaca: diagnóstico y tratamiento en un centro de referencia / Infections in cardiac implantable electronic devices: diagnosis and management in a referral center

Introducción y objetivos: Las infecciones en dispositivos de electroestimulación cardiaca son cada vez más frecuentes debido a las indicaciones cada vez más amplias de estos sistemas. Algunos aspectos sobre su tratamiento son controvertidos y aportamos aquí nuestra amplia experiencia. Métodos: Se atendieron 325 infecciones (196 locales y 129 sistémicas) durante los años 1985 a 2015, el 28,5% de ellas procedentes de otros centros: 229 marcapasos, 69 desfibriladores automáticos implantables y 27 pacientes con terapia de resincronización cardiaca, con un seguimiento mínimo de 1 año tras el alta hospitalaria. Resultados: La tracción percutánea (TPC) fue la técnica utilizada más frecuentemente (n = 280), en infecciones tanto locales (n = 166) como sistémicas (n = 114), con una tasas de extracción completa del sistema del 82,5% del total y de curación, del 89%; las complicaciones fueron escasas (2 muertes achacables a la técnica). La mortalidad total fue del 1% en infecciones locales y el 8% en las sistémicas. Tras 212 TPC completas, se reimplantó un nuevo sistema contralateral en 209: en 152 de ellas en el mismo acto (73%) y en 57 en un segundo tiempo; no se apreciaron diferencias en el número de recidivas en el nuevo sistema (2 en 1 tiempo y 1 en 2 tiempos). Conclusiones: La TPC en manos expertas arroja buenos resultados en términos de eficacia, con escasas complicaciones. Se puede realizar el reimplante de dispositivos en un solo tiempo sin que ello conlleve un mayor riesgo de recidiva (AU)

Introduction and objectives: Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience. Methods: Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge. Results: Percutaneous traction (PCT) was the most frequent procedure (n = 280) in local (n = 166) and systemic infections (n = 114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure). Conclusions: Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse (AU)

Infections in Cardiac Implantable Electronic Devices: Diagnosis and Management in a Referral Center.

INTRODUCTION AND OBJECTIVES: Infections in cardiac implantable electronic devices are increasing due to the expansion of the indications of these devices. The management of some aspects is controversial. Here, we report our broad experience. METHODS: Between 1985 and 2015, 325 infections (196 local and 129 systemic) were registered; 28.5% of them were referred from other centers: 229 pacemakers, 69 implantable cardioverter-defibrillators, and 27 patients with cardiac resynchronization therapy. The follow-up was at least 1 year after hospital discharge. RESULTS: Percutaneous traction (PCT) was the most frequent procedure (n=280) in local (n=166) and systemic infections (n=114), with complete extraction of the system in 82.5% of the patients, clinical success in 89%, and few complications (2 deaths attributable to the technique). Overall mortality was 1% in local infections and 8% in systemic infections. After 212 complete PCT, a new device was placed in 209: of these, a contralateral system was implanted in the same procedure in 152 (73%) and in a second procedure in 57, with no differences in relapses (2 in the 1-stage procedure, and 1 in the 2-stage procedure). CONCLUSIONS: Percutaneous traction in experienced hands has good results with very few complications. It is possible to perform contralateral implantation of the new device on the same day without increasing the risk of relapse.

Registro Español de Ablación con Catéter. XIV Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2014) / Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014)

Introducción y objetivos: Se detallan los resultados del Registro Español de Ablación con Catéter año 2014. Métodos: La recogida de datos se llevó a cabo mediante dos sistemas: retrospectivo, mediante cumplimentación de un formulario, y prospectivo, a través de una base de datos común. La elección de uno u otro fue voluntaria de cada uno de los centros. Resultados: Se recogieron datos de 85 centros. El número total de procedimientos de ablación fue 12.871, con una media de 149,5 ± 103 procedimientos. Los tres sustratos abordados con más frecuencia fueron la taquicardia intranodular (n = 3.026; 23,5%), la ablación del istmo cavotricuspídeo (n = 2.833; 22,0%) y la fibrilación auricular (n = 2.498; 19,4%). La ablación de arritmias ventriculares ha permanecido estable, con un ligero incremento de todos los sustratos ventriculares, en especial las taquicardias ventriculares idiopáticas y las asociadas a cicatriz tras infarto. La tasa total de éxito fue del 95%; la de complicaciones mayores, del 1,3% y la de mortalidad, del 0,02%. Conclusiones: En el registro del año 2014 se mantiene una línea de continuidad ascendente en el número de ablaciones realizadas y muestra, en líneas generales, una elevada tasa de éxito y bajo número de complicaciones. Continúa el aumento del abordaje de sustratos más complejos (AU)

Introduction and objectives: This report presents the findings of the 2014 Spanish Catheter Ablation Registry. Methods: For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. Results: Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5 ± 103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n = 3026; 23.5%), cavotricuspid isthmus (n = 2833; 22.0%), and atrial fibrillation (n = 2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%. Conclusions: The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase (AU)

Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014).

INTRODUCTION AND OBJECTIVES: This report presents the findings of the 2014 Spanish Catheter Ablation Registry. METHODS: For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. RESULTS: Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5±103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n=3026; 23.5%), cavotricuspid isthmus (n=2833; 22.0%), and atrial fibrillation (n=2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%. CONCLUSIONS: The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase.

Registro Español de Ablación con Catéter. XIII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2013) / Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013)

Introducción y objetivos: Se detallan los resultados del Registro Español de Ablación con Catéter del año 2013. Métodos: La recogida de datos se llevó a cabo mediante dos sistemas. De forma retrospectiva con la cumplimentación de un formulario y de forma prospectiva a través de una base de datos común. La elección de una u otra fue voluntaria para cada uno de los centros. Resultados: Se recogieron datos de 80 centros. El número total de procedimientos de ablación fue 11.987, con una media de 149±105 procedimientos. Los tres sustratos abordados con más frecuencia fueron la taquicardia intranodular (n=2.959; 24,6%), la ablación del istmo cavotricuspídeo (n=2.700; 22,5%) y la fibrilación auricular (n=2.201; 18,4%). La ablación de arritmias ventriculares ha permanecido estable, pero han aumentado discretamente los procedimientos sobre las asociadas a cicatriz tras infarto. La tasa total de éxito fue del 94,4%; la de complicaciones mayores, del 1,8% y la de mortalidad, del 0,03%. Conclusiones: En el registro del año 2013 se mantiene una línea de continuidad ascendente en el número de ablaciones realizadas y muestran, en líneas generales, una elevada tasa de éxito y bajo número de complicaciones. Continúa el aumento del abordaje de sustratos más complejos

Introduction and objectives: This report presents the results of the 2013 Spanish Catheter Ablation Registry. Methods: Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods. Results: Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%. Conclusions: In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase

Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013).

INTRODUCTION AND OBJECTIVES: This report presents the results of the 2013 Spanish Catheter Ablation Registry. METHODS: Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods. RESULTS: Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%. CONCLUSIONS: In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase.

Miocardiopatía hipertrófica y desfibrilador automático implantable / Hypertrophic cardiomyopathy and the implantable cardioverter–defibrillator

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[Drug bradyarrhythmias as a cause of hospital admission. Study of 83 cases]. / Bradiarritmias secundarias a fármacos como causa de ingreso hospitalario. Estudio de 83 casos.

BACKGROUND AND OBJECTIVE: The frequency and circumstances associated with drugs-induced bradiarrhythmia (DB) causing hospital admission are little known. PATIENTS AND METHOD: Retrospective analyses of DB in Cardiology (CD) and Internal Medicine (IMD) Departments of a 3rd level hospital over two consecutive years. RESULTS: We detected 83 cases (mean age: 72.68, 75.9% women). Most frequent DB was slow atrial fibrillation (55.4%). DB were due to the use of one drug in 41 cases and to an association in 42 cases. Most frequently involved drug was digoxine (62.7%). DB were due to the use of one drug in 41 cases and to an association in 42 cases. Most frequently involved drug was digoxine (62.7%), which was commonly associated with another drug (69.3%). Most frequent pharmacological associations were negative chronotropic drugs (57.1%) followed by their association with a diuretic and/or an angiotensin converting enzyme inhibitor (42.8%), causing renal failure and/or potassium imbalance. CONCLUSIONS: Drugs-induced bradiarrhythmia is a frequent cause of hospital admission in aged people, especially women, and is frequently due to drugs associations and/or renal failure.

Bradiarritmias secundarias a fármacos como causa de ingreso hospitalario. Estudio de 83 casos / Drug bradiarrhythmias as a cause of hospital admission. Study of 83 cases

FUNDAMENTO Y OBJETIVO: La información sobre las bradiarritmias secundarias a fármacos (BRSF) causantes de ingresos hospitalarios es escasa. El objetivo de este trabajo fue estimar la magnitud y las consecuencias de la BRSF en nuestro ámbito. PACIENTES Y MÉTODO: Análisis retrospectivo de los pacientes con BRSF ingresados en los Servicios de Cardiología (SC) y Medicina Interna (SMI) de un hospital terciario durante dos años consecutivos. RESULTADOS: Hallamos 83 casos (edad media: 72,68 años), de los que el 75,9 por ciento correspondió a mujeres. La BRSF más frecuente fue la fibrilación auricular (FA) lenta (55,4 por ciento). Dichas BRSF se debieron a un fármaco en 41 casos y a una asociación en 42. La digoxina fue el fármaco más frecuentemente implicado (62,7 por ciento), a menudo asociada a otro fármaco (69,3 por ciento). La asociación más frecuente fue la de fármacos cronotropos negativos (58 por ciento), seguida de la de éstos con un diurético y/o inhibidor de la enzima conversiva de la angiotensina (IECA) (42,8 por ciento), condicionando insuficiencia renal y/o alteraciones del potasio. CONCLUSIONES: Las BRSF son un frecuente motivo de ingreso en personas mayores, sobre todo mujeres, a menudo debido a asociaciones farmacológicas y/o insuficiencia renal (AU)

[Normal conventional electrocardiogram with negative pharmacological stress test does not rule out Brugada syndrome]. / El electrocardiograma convencional normal con test de provocación farmacológico negativo no descarta el síndrome de Brugada.

The diagnosis of Brugada syndrome, or right bundle-branch block with an elevated ST segment and negative T waves in V1-3, is obscured by the transitory normalization of the electrocardiogram, which can be unmasked by administering sodium-channel blockers. It has been recently reported that the condition can be underdiagnosed if only conventional precordial leads are used. We present the cases of two asymptomatic patients, a mother and son, with a family history of sudden cardiac death in first-degree relatives. Baseline ECGs obtained in conventional leads and one and two intercostal spaces above conventional electrode sites were similar, normal in the mother and saddle-like in the son. A flecainide stress test elicited the characteristic pattern of Brugada syndrome in both patients, but only in the high leads. Pharmacological stress testing with conventional precordial lead recordings does not rule out Brugada syndrome. We recommend that ECG recordings should include leads in the second and third intercostal spaces.

El electrocardiograma convencional normal con test de provocación farmacológico negativo no descarta el síndrome de Brugada / Normal conventional electrocardiogram with negative pharmalogical stress test does not rule out Brugada syndrome

El diagnóstico del síndrome de Brugada, bloqueo de rama derecha con segmento ST elevado y ondas T negativas de V1-3, se encuentra dificultado por la normalización transitoria del electrocardiograma, y puede ser desenmascarado por los bloqueadores de los canales de sodio. Recientemente se ha comunicado su posible infravaloración con la sola utilización de las derivaciones precordiales convencionales. Presentamos los casos de 2 pacientes asintomáticos, madre e hijo, con antecedentes familiares de primer grado de muerte súbita. Los ECG basales en las derivaciones precordiales convencionales y en uno y dos espacios intercostales por encima fueron similares, normal en la madre y en 'silla de montar' en el hijo. Tras test de flecainida, ambos desarrollaron el patrón electrocardiográfico típico del síndrome de Brugada exclusivamente en las derivaciones superiores. El test de provocación farmacológico con las derivaciones convencionales no descarta el síndrome de Brugada, y es necesario incluir sistemáticamente las derivaciones precordiales en el segundo y tercer espacios intercostales (AU)