Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study

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.