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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Cardiac device-related infective endocarditis: a challenge condition
Session:
Posters 2 - Écran 04 - Arritmologia - Dispositivos
Speaker:
Helena Filipa Marinho Nascimento Guedes
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Posters
FP Number:
---
Authors:
Helena M. Nascimento; Marta Braga; Luís Flores; Vânia Ribeiro; Filipa Melão; Paula Dias; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction and</strong> <strong>purpose:</strong> In the last decades, the number of cardiac devices has grown exponentially. Cardiac device-related infectiveendocarditis (CDRIE) is a fearful complication, accounting for 10-23% of all cardiac device infections. Diagnosis and management of this condition remains a challenge. The aim of this study was to assess clinical and prognostic profile of CDRIE patients (pts).</p> <p><strong>Methods: </strong>A retrospective study of 173 consecutive diagnosed infective endocarditis (IE), admitted to several departments in a tertiary center from 2011 to 2014. Data were collected from the electronic clinical process and registered in an uniform base.</p> <p><strong>Results: </strong>Among the IE cases studied, 16 cases were CDRIE (9%). Mean age was 62±22 years-old and 63% were males. The most common comorbidity was diabetes (25%). Intracardiac device was a pacemaker in 12 cases and a implantable cardioversor-defibrillator in the other 4. Average time from device implantation/replacement procedure to diagnosis was 64 months (range 7-86). No previous cases of IE were present; 50% of the cases were health-care associated IE.</p> <p>Fever was the predominating signal at hospital presentation (69%). Staphylococci species were the main causative microorganisms (25% coagulase negative and 44% S. aureus) and almost one­fifth of the episodes were caused by methicillin­resistant strains. Most pts had isolated infection of the the cardiac leads (75%), however 3 pts had also involvement of the tricuspid valve and 1 pt had left­side involvement. </p> <p>Lead vegetations were identified in 44% by transthoracic echocardiography and in 56% by transesophageal approach; vegetations were multiple in 11 cases and large (>10mm) in 2 cases. </p> <p>Complications developed during the clinical course were renal failure (19%), persistent infection(50%), heart failure (31%), shock (25%) and systemic embolism (19%).</p> <p>Most of the patients underwent surgical or percutaneous removal of the infected system (88%). Three pts died during the hospital stay.</p> <p><strong>Conclusion: </strong>CDRIE is a rising problem, with major diagnostic and therapeutic barriers. The clinical evolution is characterized by serious complications. Therefore, a high level of suspicion is of paramount importance to an accurate CDRIE diagnosis and treatment.</p>
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