Perfil clínico e evolução de pacientes com infecção relacionado com os dispositivos cardíacos eletrônicos implantáveis no Hospital das Clinicas da UFMG do período de janeiro de 2001 a janeiro de 2017

Abstract

Background: There was an expressive increase (210%) in the incidence of infections related to implantable electronic cardiac devices (IECD) in the last 15 to 20 years, reaching an incidence of up to 19.9%, according to literature data. Thus, it is essential knowledge of this condition, with analysis of the clinical profile and the evolution of the patients with these devices, this being the purpose of the work. Methods: This is an observational, longitudinal and retrospective study with 6,406 procedure, undergoing IECD between January 2001 and January 2017 in a single university hospital. Patients who presented infection related to IECD were evaluated under clinical and laboratorial aspects, treatment and outcome. Results: 123 patients with a mean age of 60.1 ± 19.4% were identified, and 71 (57.7%) were males, with an average of 1.7 implant procedures. The predominant cardiopathies were chronic chagasic cardiopathy in 55 patients (44.7%) and dilated by another etiology in 24 (19.5%). IECD were pacemaker VVI mode in 47 (38.2%) patients, DDD mode in 41 (33.3%), AAI mode in three (2.4) implantable cardioverter defibrillator in 24 (19.5%) and cardiac resynchronization therapy in 11 (9.0 %). Among comorbidities, there was a predominance of systemic arterial hypertension. The median interval between the implant and the diagnosis of infection was 138.5 days. The main etiological agent was staphylococcus in 63 (51.2%) patients. Transesophageal echocardiography was performed in 91 (73.9%) patients. The mean time of hospitalization was 35.3 days, and the total removal of the system was done in 105 (85.4%) patients. The most commonly used antibiotic was vancomycin in 91 (73.9%). Seventy-one patients had bacterial endocarditis and 23 had sepsis during hospitalization. Other predominant complications were worsening of renal function in 37 (30.0%) patients and pulmonary thromboembolism in 27 (21.9%). In-hospital mortality was 19.5% (24 patients). There was association (chi-square and Mann-Whitney test) between endocarditis and generator extrusion (p=0.045) and sepsis (p=0.010). There was also a significant association between in-hospital mortality and endocarditis (p = 0.005) and sepsis (p <0.0001). Ninetynine patients were discharged from hospital. During the mean clinical follow-up was 43.8 months, the mortality rate was 43.0%. Kaplan-Meier survival curve showed no significant association with gender, type of device, etiologic agent, ejection fraction <0.50, course of infective endocarditis during hospitalization and treatment modality (only antibiotic therapy, partial or total removal of the system). Based on the prognostic sepsis during their hospital, mortality was 69.5%, p <0.0001 (long-rank test). The mortality rate was 32.8% among patients submitted to endocardial reimplantation of electrodes and 52.2% among those submitted to epicardial implantation with.Conclusions: The infection rate was 1.9%, predominantly in men and in patients with dilated cardiomyopathy. The incidence of infective endocarditis was 57.7% and sepsis was 18.7% during hospitalization. Total system removal was performed in most patients. The in-hospital mortality rate was 19.5% and there was an association with endocarditis and sepsis. After hospital discharge, the annual mortality rate was 11,8%, with influence the occurrence of sepsis during hospitalization and epicardial implantation.