LEAD DEPENDENT INFECTIVE ENDOCARDITIS- IN WHOM AND WHEN? PREDISPOSING FACTORS
A. Polewczyk1, A. Kutarski2, A. Tomaszewski 2, K. Boczar3, M. Janion1,4
1District Hospital, II Clinical Cardiology Department Kielce, Poland 2Medical University, Department of Cardiology Lublin, Poland 3Department of Electrocardiology, John Paul II Hospital, Krakow, Poland 4The Jan Kochanowski University, Department Sciences of Healthy Kielce, Poland
Background: Lead dependent infective endocarditis (LDIE) is a very severe, perfidious disease. The factors influencing LDIE development are relatively poor documented.
Methods: We reviewed clinical data of 1220 patients treated by transvenous leads extraction (TLE) in single Reference Center in years 2006-2012 and separated 320 LDIE cases. Demographic and clinical data were collected and LDIE predisposing factors were assessed.
Results: The results were demonstrated in the table.
Conclusions: LDIE could be influenced by clinical and procedural factors. The present study demonstrated increase of the risk of lead dependent infective endocarditis in older, diabetic, male patients. LDIE development is also connected with the higher number of previous procedures with the bigger number of implanted leads, particularly abandoned leads presence. Moreover, LDIE can be affected by unnecessary too long loops of the leads. Very important is a little known intracardiac abrasion leads phenomenon.
|
|
LDIE
|
Control group- non LDIE patients
|
P
|
| No of patients
Mean age [years (SN)]
Sex (women %) |
320
66,3 ±15,0
98 (30,6%)
|
900
63,75 ±17,3
358 (39,8%)
|
0,02
0,005
|
| Diabetes [%] |
70
21,9%
|
15517,2% |
0,06 |
| Renal insufficiency [%] |
14
4,5%
|
23
2,6%
|
0,1 |
| Sternotomy in anamnesis [%] |
46
14,4%
|
132
14,7%
|
0,88 |
| Mean number of leads before TLE [SN] |
2,2±0,82 |
1,9±0,78 |
0,0001 |
| Mean lead dwelling time before TLE [months (SD)] |
89,1(±63,7) |
83,7(±64,7) |
0,20 |
| Number of procedures before TLE (SD) |
2,27(±1,44) |
1,85(±1,13) |
0,0001 |
| Unecessery loop of lead [%] |
8426,2% |
16718,6% |
0,004 |
| Number of abandoned leads (SD) |
0,31(±0,67) |
0,23 (±0,57) |
0,04 |
| Intracardiac abrasion of the leads [%] |
98
30,6%
|
168
18,7%
|
0,0001 |
