Abstract 19003: Long-term Outcomes After Subcutaneous Defibrillator Implantation in Patients With a Previous Device Infection

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Introduction: Long-term outcomes for S-ICD reimplantation after a prior CIED infection are unknown.

Hypothesis: S-ICD infection and death are not increased in those with a prior CIED infection.

Methods: This was a single center retrospective study of patients undergoing S-ICD implantation from 2010 to 2016, comparing those had a prior CIED infection requiring extraction to those without a prior infection. The primary composite outcome was death and S-ICD infection. Survival analysis was performed with Kaplan Meier curves, log-rank tests, and Cox regression.

Results: 174 patients were included, 28 with a prior CIED infection and 146 without a prior infection. Follow-up was similar for those with and without (median 21 months, IQR 11-41; p-value 0.11) a prior CIED infection. Those with a prior infection were older (60 years; 95% CI 54-65 vs 52 years; 95% CI 50-55; p-value 0.03), but the groups were similar regarding gender (71% male; p-value 0.35), EF (37%; 95% CI 35-40; p-value 0.76), ICD indication (29% secondary prevention; p-value 0.18), and NYHA class III or IV heart failure (13%; p-value 0.13). There was no difference in the primary outcome between groups (HR 1.1; 95% CI 0.4-3.2) (figure). There was no difference between groups regarding hematoma (p-value 0.59), S-ICD infection (p-value 0.41), hospitalization (p-value 0.54), inappropriate shock (p-value 0.45), or death (p-value 0.97). Patients with a prior CIED infection had more appropriate shocks (29% vs 14%; p-value 0.05). Significant univariable predictors for death and infection included NYHA class, ESRD, OSA, COPD, DM, atrial fibrillation, history of VT, CAD, and age. The only independent predictor in multivariable analysis was NYHA class (HR 2.6; 95% CI1.4-5.0; p-value < 0.01), while prior CIED infection was not significant (HR 0.6; 95% CI 0.2-2.3; p-value 0.46).

Conclusion: S-ICD implantation after CIED infection requiring extraction is not associated with an increased risk of device infection and death.

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