Elsevier

Heart Rhythm

Volume 3, Issue 8, August 2006, Pages 919-923
Heart Rhythm

Original-clinical
Fungal infection of implantable cardioverter-defibrillators: Case series of five patients managed over 22 years

https://doi.org/10.1016/j.hrthm.2006.04.012Get rights and content

Background

With the increasing use of implantable cardioverter-defibrillators (ICDs), device complications are becoming more common. Fungal-related ICD infections have rarely been reported, and little is known about the presentation, prevalence, and treatment options for these morbid infections.

Objectives

The purpose of this study was to characterize the clinical features, treatment, and outcomes of patients with fungal ICD infections.

Methods

We performed a retrospective review of ICD procedures performed at a single academic center and identified all ICD-related infections managed between 1983 and 2005.

Results

Among a total of 3,648 ICD-related procedures performed between 1983 and 2005, we identified 47 (1.3%) cases of ICD infections, of which 5 (0.1%) were due to a fungal pathogen. Fungal infections were more likely to be associated with abdominal devices, to have a local rather than systemic infection, and to have a longer duration from the original implant to presentation. All patients were treated with ICD system explantation and antifungal therapy.

Conclusion

Fungal infection of ICDs is a rare but serious complication of device implantation that must be treated aggressively with complete hardware explantation and prolonged antifungal therapy. Because most infections are late complications and have indolent onsets, a high level of clinical suspicion is required for early diagnosis.

Section snippets

Methods

Patients who underwent an ICD procedure, including primary implantation, generator change, and lead revision or upgrade, between April 1, 1983 and October 1, 2005 were identified through a centralized database maintained in the ICD clinic at Massachusetts General Hospital. All cases with a documented infection were selected, and basic patient demographic information, patient clinical characteristics, pathogenic organisms, and treatment course were obtained. From this group, five cases were

Results

Between 1983 and 2005, 3,648 ICD-related procedures were performed at Massachusetts General Hospital. Forty-seven infections (1.3%) were diagnosed and treated at our hospital; 5 (0.1%) were due to a fungal pathogen (Table 1). Among all infected devices, abdominal devices were more commonly involved with a fungal ICD infection, and all but one patient had undergone multiple lead revision or generator change procedures before the infection. The median length of time from initial implantation to

Discussion

In this case series, we reviewed the 3,648 ICD procedures performed at our institution between April 1983 and October 2005. We found that the overall infection rate was 1.3% whereas the rate of fungal infections was 0.1%. To our knowledge, six other cases of fungal ICD infections have been reported in the literature.9, 12, 13, 14, 15, 16 Among these cases, two had endocarditis with lead vegetations and manifestation of systemic illness.15, 16 The remaining cases involved local infections of one

Conclusion

We observed a 0.14% prevalence for fungal infections of ICD systems. Abdominal generators were affected more often than were pectoral devices, and local infections were more common than was fungal endocarditis. Most infections were delayed complications and had an indolent onset. Although fungal ICD infections are rare and lack consensus to support standardized treatment approach, treatment typically includes device explantation and prolonged antifungal therapy with or without lifelong

References (20)

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This project is supported by National Institutes of Health Grant HL71632 to Dr. Ellinor.

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