Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Quality Measures & Complications D-MP07 - The A Through Z for CIEDs (ID 55) Moderated ePoster

D-MP07-04 - Procedural Predictors Of Cardiac Implantable Electronic Device (CIED) Infection: Insights From The WRAP-IT Study (ID 842)


  K.G. Tarakji: Honoraria/Speaking/Consulting Fee - Boston Scientific; Medtronic; AliveCor.

Video File Upload


Background: Modifiable procedure-related risk factors for cardiac implantable electronic device (CIED) infection are not well-defined and techniques to minimize infection lack supportive evidence. WRAP-IT, a large study assessing an antibiotic envelope (TYRX) to reduce CIED infections offers an opportunity to evaluate procedural details and techniques for insight into infection prevention strategies.
Objective: Identify modifiable procedure-related factors associated with infection among patients undergoing secondary CIED procedures.
Methods: This analysis included 2821 patients randomized to the control arm whom did not receive an envelope (44 patients with infections). A multivariate LASSO machine learning model performed variable selection and parameter estimation. Variables consistently retaining predictive value across iterations of imputed data (proportion >0.10) were deemed significant while controlling for baseline demographics and non-modifiable procedural variables.
Results: Procedural characteristics associated with significantly increased infection risk included use of vancomycin as the peri-procedure antibiotic, complete capsulectomy, antiplatelet (aspirin) use, and oral anticoagulant therapy at the time of procedure (Table). Apixaban use at the time of the procedure was associated with lower infection rates than warfarin and others. Decreased risk was seen with the use of chlorhexidine for skin preparation, and antibacterial pocket wash.
Conclusion: This WRAP-IT analysis identified procedural factors that impact the risk of major CIED infection. Consideration of these factors can help guide infection prophylaxis strategies.